SEP 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 72 of 98

September 2013 Helping continued from page 69 onto the eye were also the least adherent to daily therapy at home. When they compared the visual field progression rates of this subset to the rest of the group (those hitting the eye with two or fewer attempts), they found an important difference. "The annual rate of visual field progression was –0.91 dB per year in the poorly adherent group, compared to only –0.52 dB per year in the better adherent group," she said. This difference was just barely significant with p=0.05. "Granted this finding is of marginal significance and is present at an arbitrary cut-off," she said. But she pointed out that most eye drop bottles contain little more than the precise amount for 30 days of dosing. "If they use more than one drop per dose, they will run out of drop before they are eligible to refill the prescription." This untreated period may be contributory to progression. Robert Stamper, MD, University of California-San Francisco, agreed. "This makes the point that 30 drops is not equal to 30 days of therapy." He added, "Faced with either paying out of pocket or not taking their drops, I suspect that many patients go through that 5–7 day period at the end of the month without therapy." Non-adherence isn't just forgetting We often ask patients if they take their drops regularly. We don't often ask if they actually get a drop in the eye consistently. Patients may say they take their drops regularly, but a drop on the cheek doesn't lower intraocular pressure. Meghan Park, MD, and colleagues at Northwestern University in Chicago conducted a videotaped study of glaucoma patients instilling eye drops (artificial tears for the purpose of the study). On the bright side, 90% of patients successfully got an eye drop into their eye, she said. However, the average number of drops used from the bottle in order to get one on the ocular surface was approximately two drops. This underscores Dr. Schmidt's and Dr. Stamper's concern about running out of medication before the end of the month. Also of concern, nearly 35% of patients contaminated the eye drop bottle by touching the tip to the ocular surface. Improving adherence through education The American Academy of Ophthalmology (AAO, San Francisco) has developed a 10-minute video presentation aimed at helping patients understand glaucoma and the importance of adherence to therapy (available at the AAO online store at store.aao.org). Shani Reich, MD, and colleagues at Bronx-Lebanon Hospital and Albert Einstein College of Medicine, Bronx, N.Y., recently conducted a study to validate the impact of this video on adherence with glaucoma therapy in African American and Hispanic patients (the video is available in both English and Spanish). Patients whose glaucoma was controlled on a prostaglandin analogue were enrolled in the study and used the Travatan Dosing Aid (TDA) for a month to measure baseline adherence. "The TDA is an electronic monitor that captures when patients squeeze their bottle of travoprost to administer the drop," said Dr. Reich. Patients with baseline adherence showing fewer than 75% of doses taken in one month were randomized to see the video and receive verbal reinforcement of adherence or just to get verbal reinforcement, after which adherence was monitored for an additional two months with the TDA. "Overall, adherence improved from 25% to 50% after the intervention," said Dr. Reich. This was in contrast to the control group, in which adherence did not change (29% to 32%). "In Hispanics, the intervention improved adherence from 24% to 51%, and in AfricanAmericans it improved from 28% to 45%." All of these improvements were statistically significant, with no changes in the control groups by ethnicity. "Our results demonstrate the potentially significant impact of educational intervention on adherence to medical therapy in the Hispanic and African-American population," concluded Dr. Reich. These are two populations at particularly high risk for both glaucoma and glaucoma-related vision loss. Best of all, the intervention requires almost no physician time—the patient can watch the video in the waiting room. EW Editors' note: The physicians have no financial interests related to this article. Contact information Reich: shani.reich@gmail.com Schmidt: jimeschmidt@gmail.com Stamper: stamperr@vision.ucsf.edu

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