Patient Compliance To Treatment In The Management Of Glaucoma And Factors Affecting It.

Patient Compliance To Treatment In The Management Of Glaucoma And Factors Affecting It.

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  Dr. Varsha G.Bapat Dr . Poonam Gandhi RED CROSS OPHTHALMOLOGY SERVICES ,IRCS PUNE Patient compliance to treatment in the management of glaucoma and factors affecting it.
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  Patient compliance totreatment in the management of glaucoma and factors affecting it. INTRODUCTION  Glaucoma is a chronic progressive and often asymptomatic disease.  Characteristically intraocular pressure related optic neuropathy.  Preventable blindness if treatment is regular and effective.  Well established role of anti glaucoma topical therapy.  Wide options and availability of topical anti glaucoma agents
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  Patient compliance totreatment in the management of glaucoma and factors affecting it. Purpose  To set up a protocol of managing glaucoma in an effective way to address mainly the issue of patient compliance to treatment.  We aim to start this prospective analysis for every glaucoma patient assessing his compliance to treatment and factors affecting it thus achieving a better control on progression of disease by implying measures
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  Patient compliance totreatment in the management of glaucoma and factors affecting it. Material and methods:  Evaluation using routine slit-lamp examination with gonioscopy, applanation tonometry, Humphrey’s visual field test, pachymetry, optical coherence tomography and phasing as appropriate.  Inclusion of patients with established diagnosis of glaucoma (irrespective of the glaucoma type)  Patient counseling regarding the nature of disease and importance of regular treatment and attending follow up.  He is taught right method of drop instillation.  During follow up visits intraocular pressures are measured, slit lamp biometry is performed and field tests are advised as appropriate to assess the disease management.  The drop instillation technique is supervised and compliance issue is also reinforced.
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  Patient compliance totreatment in the management of glaucoma and factors affecting it. RESULTS Its an ongoing project aiming to lead to a prospective study with minimum of 100 patients, total number of patients attended outpatient department from 1 January 2016 till date is 880, so far 15 patients are enrolled in glaucoma clinic. Amongst 15 glaucoma patients , 10 are male and 5 are female ( male :female ratio-2:1). As the diagnosis confirmed was 3 patients of glaucoma suspect(20%), 7 patients of primary open angle glaucoma(46.66%), 2 of angle closure glaucoma(13.33%) and rest 3 of secondary glaucoma(20%). Majority of patient with poor control and who lost follow up were from low socioeconomic status with poor education level. However overall compliance to treatment was poor in all the patients and they needed continuous reminder for adherence to regimen on every follow up visit. We aim to continue this protocol of management and hope to enroll all the patients with the diagnosis of glaucoma, also stressing the importance of compliance to enhance the impact of therapy and thus achieve better control on the disease.
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  Patient compliance totreatment in the management of glaucoma and factors affecting it. Discussion:  Glaucoma is second leading cause of preventable non reversible blindness worldwide (WHO). A population-based study in southern India demonstrated that glaucoma was the second leading cause of bilateral blindness, being responsible for 10% of cases detected in their study population.1  With the advent of newer medical therapies in this field it has become easy to treat the disease with multiple options. However adherence to the regular treatment and follow ups remain a big issue in the control of the disease.
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  Patient compliance totreatment in the management of glaucoma and factors affecting it.  Quigley makes a case for why clinicians should seriously consider this problem.2  “If we could help patients with glaucoma take their drops better, it would be like doubling the effect of their treatment – the equivalent of adding a second drop. This is true because, on average, patients with chronic medical conditions take from 30% to 70% of prescribed medication doses, and up to half discontinue medications in the first months of therapy.3, 4 These dismal facts apply to the use of eye medicines as well.5  Education relating to eye drop instillation technique is significantly associated with a patient's ability to instill drops correctly. The assessment of a patient’s ability to instill eye drops correctly should be a routine part of the glaucoma examination.6
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  Patient compliance totreatment in the management of glaucoma and factors affecting it.  Conclusion:  In this prospective study we are trying to look into the very issue of compliance and identify the factors affecting it. Also we attempt to look into various devices and techniques if practically implicated to achieve better compliance for our patients.  Majority of our patients with poor control belong to low education level and poor socioeconomic status.  The successful medical treatment of glaucoma relies on adherence to a topical medication regimen. For some patients this includes multiple medications instilled 7
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  Patient compliance totreatment in the management of glaucoma and factors affecting it. We recommend and aim to imply following measures to improve patient compliance: Local Measures  Handing out PATIENT INFORMATION sheets, giving detailed information about the disease treatment and prognosis.  Assessing patient’s physical ability and understanding to carry on proper instillation of eye drops.  Talking to relatives and family members to increase awareness about the treatment and familial nature of the disease, in turn increasing awareness for
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  Patient compliance totreatment in the management of glaucoma and factors affecting it.  Showing informative videos and pictures and giving treatment booklets with clear instructions for treatment and follow up dates  To use combined therapy as to minimize doses per day.  Use of auto drop or auto squeeze devices helping proper instillation of drops.  General Measures  Social help  Financial help  Free camps and seminars to increase awareness
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  Patient compliance totreatment in the management of glaucoma and factors affecting it. References:  1. . Thulasiraj RD, Nirmalan PK, Ramakrishnan R, Krishnadas R, Manimekalai TK, Baburajan NP, et al. Blindness and Vision Impairment in a Rural South Indian Population: The Aravind Comprehensive Eye Survey. Ophthalmology. 2003;110:1491–8  2. 2. Quigley HA. Improving eye drop treatment for glaucoma through better adherence.Optom Vis Sci. 2008;85(6):374–375.  3. Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. JAMA. 2002;288(22):2880–2883.  4. DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40(9):794–811.  5. Nordstrom BL, Friedman DS, Mozaffari E, Quigley HA, Walker AM. Persistence and adherence with topical glaucoma therapy. Am J Ophthalmol. 2005;140(4):598–606  6. A J Tatham, U Sarodia, F GatradA Awan .eye drop instillation technique in patients with glaucoma Eye (2013) 27, 1293–1298; doi:10.1038/eye.2013.187; published online 23 August 2013  7. Kass MA, Meltzer DW, Gordon M, Cooper D, Goldberg J. Compliance