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EW GLAUCOMA 90 October 2015 Reference 1. Barker GT, Cook PF, Schmiege SJ, Kahook MY, Kammer JA, Mansberger SL. Psychometric properties of the Glaucoma Treatment Com- pliance Assessment Tool in a multicenter trial. Am J Ophthalmol. 2015;159(6):1092–1099. Editors' note: Mr. Barker has no finan- cial interests related to this article. Contact information Barker: gbarker@deverseye.org by Michelle Dalton EyeWorld Contributing Writer patient would fill out in the doc- tor's office, and we can examine the results of this survey to help frame potential interventions in order to increase or maintain adherence to glaucoma medication," he said. However, this assessment tool uses 47 statements, "which may be too long for a busy clinical practice," Mr. Barker said. Future studies may incorporate a shorter version of the questionnaire to increase clinical use. EW considered between 22 and 26 hours from the previous dose; the dose timing rules did not apply to those on twice-daily medications (n=25) or three-times daily (n=4). Most participants (78.1%, 157/201) used a prostaglandin analogue and most (85.6%, 172/201) were on a 1-drop- a-day regimen. The Glaucoma Treatment Com- pliance Assessment Tool includes 47 statements with 5 potential respons- es (ranging from 1=disagree a lot to 5=agree a lot). The mean (+/–SD, range) adherence percentage was 79.9% (+/–18.5%, 20.3% to 100.0%). The principal component analysis loaded 24 questions into 6 components that were consistent with the Health Belief Model. These were "acceptable psycho- metric properties," Mr. Barker said. "But, unfortunately, 80% adherence still means that 20% of patients do not have appropriate treatment. We tried to replicate the clinical situa- tion with the patient needing to use the drop every day." This version of the assessment tool has "acceptable predictive validity" as well, the authors said. Specifically, questions relating to self-efficacy, barriers, and disease severity predicted adherence to the medications. Study findings Decreased glaucoma medication adherence was associated with non-white race/ethnicity, a younger age, and no marital status. There are numerous hypotheses about why non-whites have a poorer adherence but no uniform agreement; younger patients may have issues paying for medications that may lead to a poor- er compliance rate, Mr. Barker said. Sometimes having a companion is enough to remind people to take medications, so single people may be at a disadvantage, he added. The authors said their results (coupled with other studies on pre- dictability) suggest that a physical ability to instill topical medications is not the defining cause for medica- tion adherence, but that numerous factors (including psychological and behavioral factors) are equally important. "We can make this assessment with our constructed survey that a A glaucoma compliance assessment tool is proving effective at identifying those with high (and low) compliance M ore than 75 million people are expect- ed to be affected by glaucoma by 2020, and although topical glaucoma medications have been proven efficacious, issues with patient compliance and adherence plague clinicians. Using the frame- work of the Health Belief Model— which generally states that people will take action to prevent disease if they think they may contract the disease—Gordon T. Barker, Devers Eye Institute, Portland, Ore., and colleagues created the Glaucoma Treatment Compliance Assessment Tool, a "questionnaire designed to evaluate multiple behavioral factors associated with glaucoma medica- tion adherence." Now, the group revised the tool to add queries about patient/physician relationships and patient mood. 1 "We found it is possible to assess patients' beliefs and knowledge about glaucoma and the use of glau- coma medication and that we can use the results of this assessment to predict patients' adherence to their glaucoma medication," Mr. Barker said. Study details The study enrolled 201 open-angle glaucoma or ocular hypertension pa- tients from tertiary clinics who were using a single bottle of an ocular hy- potensive agent. The researchers at Devers, the University of Colorado Denver, and Vanderbilt University (Nashville, Tenn.) objectively mea- sured adherence with medication event monitoring system devices over 60 days. Study participants had to be trained to put the monitoring sys- tem cap on their medications, and the group excluded data from the first and last day, when clinicians and patients would be opening and closing the medication cap. Patients who were on once-daily medication were granted a 4-hour window; a "valid opening" was Modified assessment tool can predict compliance

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