Multifaceted behavioral interventions to improve topical glaucoma therapy adherence in adults

Area of Science:

• Ophthalmology and Vision Science
• Behavioral Medicine
• Public Health

Background:

• Glaucoma, a leading cause of blindness, necessitates consistent topical medication adherence to manage intraocular pressure (IOP).
• Low patient adherence to glaucoma medications is a significant challenge in effective disease management.
• Multifaceted behavioral interventions are explored to improve adherence to topical IOP-lowering therapies.

Purpose of the Study:

• To evaluate the impact of multifaceted behavioral interventions on adherence to topical glaucoma therapy.
• To assess the effect of these interventions on intraocular pressure (IOP) and other clinical outcomes.
• To explore the influence of social determinants of health on intervention effectiveness and adherence.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
• Searches included four electronic databases, two clinical trial registries, with a search date up to May 31, 2024.
• Seventeen RCTs involving 4536 participants were included, assessing various behavioral intervention components.

Main Results:

• Evidence for the effectiveness of multifaceted interventions on adherence is inconsistent and of very low certainty.
• Meta-analysis suggested a potential increase in adherent participants (RR 1.18), but with significant uncertainty (I² = 71%).
• Limited and mixed evidence exists for improvements in IOP and visual field stability; social determinants showed mixed influence.

Conclusions:

• The current evidence is insufficient to determine if multifaceted behavioral interventions benefit adherence or IOP in glaucoma patients.
• Heterogeneity in interventions, outcome definitions, and reporting hindered meta-analysis and certainty of findings.
• Standardized measurement and reporting, incorporating social determinants, are crucial for future research in this area.