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The Effect of Medication Adherence on Intraocular Pressure and Glaucoma Progression
Louay Almidani1, Annabelle Pan1, Chris Bradley1
1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ophthalmology. Glaucoma
|October 17, 2025
Summary
Lower medication adherence in glaucoma patients correlates with higher intraocular pressure (IOP) and faster vision loss. Factors like female gender, Black race, and greater disease severity predict poor adherence.
Area of Science:
- Ophthalmology
- Glaucoma Research
- Patient Adherence Studies
Background:
- Medication adherence is crucial for managing chronic conditions like glaucoma.
- Limited understanding exists regarding the link between medication adherence and long-term structural and functional declines in glaucoma patients.
Purpose of the Study:
- To investigate the association between medication adherence and mean intraocular pressure (IOP) in glaucoma patients.
- To determine if medication adherence predicts the rate of change in visual field mean deviation (MD) and retinal nerve fiber layer thickness (RNFLT).
- To identify factors associated with poorer medication adherence in a large cohort.
Main Methods:
- Retrospective longitudinal cohort study design.
- Utilized pharmacy refill data to calculate the Proportion of Days Covered (PDC) for medication adherence.
- Employed multivariable linear mixed-effects models to analyze relationships between PDC, mean IOP, and rates of change in MD and RNFLT.
Main Results:
- A median PDC of 60% was observed in 13,670 eyes from 8,163 patients.
- Lower PDC (<60%) was associated with significantly higher mean IOP and faster rates of MD and RNFLT loss.
- Predictors of worse PDC included female gender, Black race, worse baseline MD, lower baseline RNFLT, using multiple eye drops, and unilateral drop use.
Conclusions:
- Reduced medication adherence is linked to elevated IOP and accelerated glaucomatous damage.
- Adherence levels below the median demonstrated a stronger association with increased IOP.
- Demographic and clinical factors significantly influence medication adherence in glaucoma management.
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