Eyeworld

EW NEWS & OPINION 28 July 2017 Research highlight by Maxine Lipner EyeWorld Senior Contributing Writer ance behaviors, Dr. Wellik explained. "Those patients in particular may be avoiding whatever is triggering their anxiety in any way," she said. Vets at risk From a clinical perspective, this suggests that physicians should take such factors into account when treating glaucoma patients to ensure compliance. "As physicians, some- times we need to take a step back and ask the questions to determine whether the patients are being com- pliant and what factors might be causing them to not take their drops and address those in some way," she said. "I think it is worthwhile, given the results of the study, to ask the patients and look at the chart to see whether PTSD or anxiety is in there and address those issues." Likewise, it's important to ask patients if they're experiencing dry eye symp- toms and if it's preventing them from taking their drops. Dr. Wellik hopes that practi- tioners come away from the study with the understanding of the importance of compliance and the doctor's role in figuring out how to help improve it. This may become a matter of spending time with patients and teasing out as much information as possible on specific things that are influencing their compliance. Going forward, Dr. Wellik thinks it is particularly important to seek other ways to treat glaucoma patients. This may mean honing in on other ways to administer medi- cation, be it injection or continuous release. "This is a problem that is not going to go away, and we're not going to be able to address all of these issues. Finding other ways to treat these patients, I think that's going to be important," she con- cluded. EW Reference 1. Stringham J, et al. Barriers to glaucoma medication compliance among veterans: dry eye symptoms and anxiety disorders. Eye Contact Lens. 2017 Jan 6. Epub ahead of print Editors' note: Dr. Wellik has no finan- cial interests related to her comments. Contact information Wellik: SWellik@med.miami.edu eye. "We did find that patients who reported a higher level of dry eye had a lower compliance rate," Dr. Wellik said. "Presumably things that are unpleasant to do would cause people to not do them." This may be the result of the drops themselves or the preservatives in these that are known to increase dryness. "If patients were finding [the drops] uncomfortable or found they wors- ened their dry eye symptoms, they might be less likely to take them," Dr. Wellik said. When investigators consid- ered other factors such as anxiety, depression, and PTSD, they found that just two out of the three had an effect. "PTSD and anxiety were found to be related, but depression was not found to be an independent risk factor," she said, adding that something specific to PTSD and anxiety has more of an effect than depression. Investigators determined that 58% of those with PTSD were compliant versus 84% without the disorder; 64% of those with anxiety followed their glaucoma regimen versus 83% without this condition. One of the theories is that a factor that goes along with PTSD is avoid- Helping physicians figure out how to improve compliance in this patient group P ractitioners count on patients to follow their glaucoma drop regimens. But are there some factors in certain populations that should raise concerns among practi- tioners? In a study published in Eye and Contact Lens, 1 investigators ex- amined factors that may be obstacles to glaucoma medication compliance among veterans, according to Sarah Wellik, MD, associate professor of ophthalmology, Bascom Palmer Eye Institute, Miami. The study included 74 veter- ans on glaucoma drops who were coming to the clinic at the VA hos- pital. "It wasn't a particularly high proportion of advanced glaucoma or surgical glaucoma," Dr. Wellik said. "But we only did the survey on patients with glaucoma." Surveying the troops The 63-question survey was offered to those glaucoma patients taking Obstacles to medication compliance in veterans with glaucoma drops who came in during the inves- tigation. "We had about 80% of pa- tients willing to fill out the survey," she said. "We asked the patients, 'Do you take your drops or do you not?'" In addition, patients were asked what factors might have in- fluenced them in taking their drops or not. Factors included forgetful- ness, dry eye, anxiety, depression, and other diagnoses. In addition, investigators checked if there was a diagnosis of post-traumatic stress disorder (PTSD) documented in the patients' electronic charts. Investigators made several key determinations in terms of what factors may have influenced vet- erans in taking or not taking their glaucoma drops. While the initial assumption was that forgetfulness would be an important factor, this did not prove to be the case, Dr. Wellik reported. "We found that al- though patients said that was a fac- tor, when we correlated compliance with drops on patients who reported forgetfulness, that didn't turn out to be a critical factor," she said. Dry eye symptoms were another key part of the survey. Here 39% of patients reported issues with dry

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