Ocular Hypotensive Medications: Adherence and Performance

Glaucoma is a leading cause of blindness world-wide and first-line therapy is typically ocular hypotensive medications. Several large, multicenter trials have demonstrated that lowering intraocular pressure medically reduces the risk of glaucomatous visual field loss. However, the proportion of patients who inadequately comply with glaucoma medical therapy as prescribed ranges from 5% to 80%. In addition, instillation of eyedrops is challenging for many patients, adding another component to inadequate patient-delivered therapy. Patients who have poor understanding of the impact of glaucoma on vision are less likely to take their glaucoma drops properly. Poor adherence is associated with worse outcomes in glaucoma patients: worse visual field defects, and greater fluctuation in intraocular pressure (IOP), which also may contribute to worsening disease. Therapeutics might be enhanced by education of both the importance of medication use, and simply how to take eye drops. The financial impact of inadequate patient-delivery therapy is discussed, as are some simple proposals for improving therapeutics.