Topical Medication Adherence and Visual Field Progression in Open-angle Glaucoma: Analysis of a Large US Health Care...

Area of Science:

• Ophthalmology
• Clinical Pharmacy
• Health Services Research

Background:

• Glaucoma is a leading cause of irreversible blindness.
• Topical hypotensive medications are the cornerstone of glaucoma management.
• Patient adherence to long-term medication regimens is often suboptimal and impacts treatment efficacy.

Purpose of the Study:

• To quantify the impact of nonadherence to topical hypotensive medication on the progression of visual field defects in glaucoma patients.
• To analyze the association between medication adherence levels and the rate of glaucomatous visual field deterioration in a real-world clinical setting.

Main Methods:

• Retrospective analysis of combined visual field and pharmacy data from Kaiser Permanente (2001-2011).
• Inclusion of patients with primary open-angle glaucoma or pseudoexfoliation glaucoma and at least three visual field tests.
• Estimation of medication adherence using proportion of days covered from pharmacy refill data and analysis using a conditional growth model.

Main Results:

• A total of 6,343 patients were followed for a mean of 5.8 years, with average adherence at 73%.
• Each 10% increase in medication adherence was associated with a significant reduction (P=0.006) in mean deviation progression by 0.006 dB/year.
• Estimated time to glaucoma progression (defined as -3 dB change) was 8.3 years for 20% adherence versus 9.3 years for 80% adherence.

Conclusions:

• Improving patient adherence to topical glaucoma medication can significantly slow the rate of visual field deterioration.
• Enhanced adherence strategies may be crucial for preserving visual function and preventing blindness in glaucoma patients.
• This study highlights the clinical importance of medication adherence in managing glaucoma effectively.