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Editors Selection IGR 16-4

Medical Treatment: Persistency of topical treatment

Comment by Michael Boland on:

59872 Persistence of topical glaucoma medication: a nationwide population-based cohort study in Taiwan, Hwang DK; Liu CJ; Pu CY et al., JAMA ophthalmology, 2014; 132: 1446-1452

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This retrospective study of persistence with glaucoma medications is an important contribution in that it is based on data from a national health system (Taiwan). This fact helps to alleviate concerns about potential bias in prior studies which were limited to health insurance programs that covered only particular groups within an overall population.

At least two of the findings from this work are consistent with prior studies - those patients on treatment for a longer time and those taking prostaglandins are more likely to be refilling their medications. In addition, there are two novel findings reported: that the sex of the treating physician is important (patients with female physicians were more likely to be persistent) and that patients with a higher continuity of care are more likely to be persistent. Both of these warrant further study as potential avenues to improve persistence.

Patients with female physicians were more likely to be persistent

As with all such studies based on claims data, the measures used are a few steps removed from the actual taking of the medication by the patient. It is also true that it is difficult to determine from claims data just how long a particular prescription should last due to differences in bottle sizes, differences in drop size delivered, differences in patient accuracy, and the fact that one cannot tell whether one or two eyes are being treated. On the other hand, this study does not suffer from the problem of patients moving from one health plan to another during the period of analysis as is the case with commercial claims data.

This study is now one of many demonstrating that adherence and persistence with glaucoma medications is fair to poor in most settings. Investigators interested in this topic should turn their attention to determining the difference (or not) in the rates of glaucoma worsening in these populations.

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