Can Adherence to Topical Glaucoma Medication be Improved by Using an Audible Alarm?
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ORIGINAL RESEARCH ARTICLE
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Can Adherence to Topical Glaucoma Medication be Improved by Using an Audible Alarm? A Pilot Study G´abor Holl´o and P´eter K´othy Department of Ophthalmology, Semmelweis University, Budapest, Hungary
Abstract
Background: Adherence to long-term intraocular pressure (IOP) lowering medication is poor in patients with glaucoma, which is a significant factor in disease progression. Aim: To investigate whether objectively monitored adherence to 0.004% travoprost (Travatan®), an IOPlowering prostaglandin-analogue eye drop, improves if the audible alarm function of the monitoring device is activated. Methods: Thirty-nine consecutive patients already on self-administered once-daily (evening) travoprost medication for glaucoma received an electronic monitoring device on loan and detailed training on its use. An adherent day was defined as a day with instillation of travoprost (from the monitoring device) at 9:00 pm ± 2 hours. In the first 3-month phase of the investigation, the audible alarm function of the device was disabled, but in the second 3-month period it was activated and set for 9:00 pm. The participants continued using their other eye drops in both phases of the study. Results: Thirty-four participants completed both periods. Non-adherence (mean ± SD) was 18.4 ± 18.9% in the first period and 14.7 ± 18.9% during the second (Wilcoxon signed rank test, p = 0.059). Thus, adherence was 81.6% with the alarm function disabled, and 85.3% when the signal was activated. A significant positive correlation was found between the number of daily eye drop instillations and change of non-adherence (Spearman’s correlation, p = 0.014), showing that when more instillations were used, less marked adherenceimprovement was achieved. Conclusion: Though adherence to once-daily topical travoprost medication was satisfactorily high even without the audible alarm function being activated, a nonsignificant tendency for a further improvement of adherence was found when the audible signal was present. For patients who instilled eye drops more frequently, this improvement was significantly less. Our results suggest that using an audible alarm signal set for the time of instillation may have a role in improving adherence in patients with glaucoma who already have relatively good adherence to their medication regimen; however, further studies are required to test this hypothesis.
Background Glaucoma is one of the most frequent causes of irreversible visual damage and blindness worldwide. At the same time, adherence to commonly prescribed and effective intraocular pressure (IOP)-lowering medication is typically suboptimal or poor.[1-3] Poor adherence to medication is frequently observed, especially when long-term treatment is necessary and the disease is not at a stage associated with severe symptoms;[4] glaucoma is a typical example of such a disease. Fortunately, the introduction of elec-
tronic monitoring devices means that patient adherence to topical IOP-low
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