Interventions Improve Poor Adherence with Once Daily Glaucoma Medications in Electronically Monitored Patients

Purpose: To investigate the impact of an intervention program to improve adherence with topical, once daily therapy for glaucoma. Design: Randomized controlled clinical trial. Participants: Sixty-six patients with glaucoma being treated with a prostaglandin analog in 1 or both eyes at the Scheie Eye Institute or Wilmer Eye Institute between November 2006 and June 2007. Methods: In an observational study, participants who took 75% or fewer doses (as measured using the travoprost Dosing Aid [DA]) during an initial 3-month period were randomized into 2 groups. The intervention group watched an educational video, reviewed current barriers to drop-taking and possible solutions with a study coordinator, received regular phone call reminders, and had audible and visible reminders activated on their DA devices. The control group was told to take drops as prescribed and received no additional intervention. Main Outcome Measures: Change in drop use adherence as determined by the DA device. Results: In the 3-month observation period before randomization, intervention group patients had used a mean of 54 +/- 17% of scheduled doses, and this increased to 73 +/- 22% during the following 3-month period (P<0.001, n = 35). The control mean adherence rate of 46 +/- 23% at baseline was statistically unchanged during the follow-up observation period (51 +/- 30%, P = 0.16, n = 31). In a multivariate analysis, intervention, baseline compliance rate of <50%, and white ethnicity were predictors of improved adherence during the 3 months of intervention. The intraocular pressure (IOP) of the intervention and control groups did not change between months 3 and 6 after intervention (P = 0.96, 0.34, respectively), and there was no correlation of IOP change with adherence rate change between both groups (Pearson correlation r = 0.06, P = 0.51). Conclusions: A multifaceted intervention significantly increased adherence with glaucoma medications. Those with improved adherence were in the intervention group, had very low adherence rates at baseline, and were white. IOP did not correlate with adherence. Further research is needed to determine which components of this intervention were most effective.