The relatively recent introduction of topical CAIs, PAs, and alpha agonists has made life easier for our glaucoma patients compared to those treated just 10 to 15 years ago. Maximal medical therapy is now a combination of the nonselective beta blocker timolol and topical CAI dorzolamide morning and night, a PA at night, and an alpha agonist twice a day, for a total of five drops in each eye over the course of the day. The number of drops has been almost halved compared to the previous use of twice-daily beta blockers, twice-daily epinephrine, and miotic agents four times per day. It is still not easy to be on this medical regimen!
Even the most conscientious patient can forget when to take particular drops. In addition, most pharmacies print prescription instructions in small type that is often difficult for some glaucoma patients to read clearly. This has improved recently, with many pharmacies providing larger type when requested, but this is by no means universal. We have found that the use of a medication card along with specific verbal instruction enhances compliance. A recent study by Kharod et al.18 verified that written instructions improved patients' knowledge of their prescribed regimens. If the patient has a family member, friend, or health aide who will assist with drop instillation, make sure this party is present when the card is reviewed with the patient. The card includes the medication name and cap color, drop dosage and laterality, and specific times to take the medication. Patients may get anxious and worry that they are not spacing their medications properly during the day. By talking to the patient about daily waking, sleeping, and work activities, a reasonable schedule can be devised, and revised in the future if needed (figure 11.2).
Clinicians should ensure that patients know how to instill their eye drops. When prescribing a medication for the first time, or when faced with patients whose IOP does not improve despite seemingly adequate therapy, the clinician should have them demonstrate in the office how they administer the eye drops. This provides important information for the clinician and allows immediate feedback for the patient.
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