Eye care adherence in pediatric and elderly: Understanding and addressing the challenges

Area of Science:

• Ophthalmology and Vision Science
• Health Services Research
• Behavioral Science

Background:

• Adherence to eye care regimens is crucial for managing pediatric and elderly eye conditions.
• Nonadherence contributes to avoidable vision loss and impacts overall health outcomes.
• Existing strategies often fail to address the multifaceted nature of adherence challenges.

Purpose of the Study:

• To synthesize evidence on the magnitude, determinants, and consequences of nonadherence in pediatric and elderly eye care.
• To propose a practice- and policy-ready agenda for improving adherence.
• To define and promote "effective adherence" for optimal clinical outcomes.

Main Methods:

• Narrative review of recent evidence using the ABC taxonomy (initiation, implementation, persistence).
• Appraisal of measurement methods and identification of phase-specific barriers.
• Collection and synthesis of effective or promising strategies at patient, clinic, and system levels.

Main Results:

• Nonadherence, particularly in initiation and implementation phases, leads to preventable vision loss.
• Objective adherence measures show lower rates than self-report.
• Multicomponent, age-tailored interventions (e.g., relational care, regimen simplification, caregiver support) are more effective than education alone.

Conclusions:

• Improving adherence requires a systematic approach addressing patient, caregiver, and system-level factors.
• Co-designed, adequately supported interventions and digital tools (with safeguards) show promise.
• A three-pillar roadmap (Clinical, Research, Policy/System) is proposed to embed measurement, support, and accountability in routine care for equitable vision outcomes.