Compliance with Ocular Medication

POUYA N. DAYANI and MICHAEL A. KASS

One of the most difficult challenges in treating glaucoma is ensuring patient compliance with medication. Compliance can be defined as taking a therapeutic regimen prescribed by a physician. Compliance is more than simply "following the doctor's orders.'' It requires an active role on the part of the patient to schedule and attend office appointments, fill prescriptions, and take medicines as prescribed. Implied in the concept of compliance is the understanding that the patient will report any medication side effects or other concerns to the physician without independently altering the regimen. It is important to define three other terms related to medical therapy: defaulting, persistence, and adherence. Defaulting is defined as failure to comply, that is, not following a therapeutic regimen. Persistence is a measure of time that the patient is taking a medication—the time between starting and discontinuing a particular drug. Adherence is a measure of doses taken, that is, the extent to which a patient takes the correct number of doses of medication at the appropriate time intervals.

In most cases, it is challenging for ophthalmologists to identify which patients are noncompliant, especially given that noncompliance is not highly correlated with demographic variables, such as age, sex, race, or socioeconomic status. The largely asymptomatic nature of glaucoma, coupled with medical therapy that is costly, may produce side effects, and often requires multiple daily doses, places glaucoma patients at particular risk for defaulting from therapy. It is thus essential that the ophthalmologist (1) understand the reasons for noncompliance, (2) recognize that defaulting is a common reason for failure of medical treatment, and (3) attempt to improve compliance. This chapter reviews these issues and discusses some practical ways to help patients comply with their glaucoma medical regimens.

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