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Editors Selection IGR 21-1

Prevention and Screening: Raising Glaucoma Awareness

Comment by Andrew Tatham on:

76015 The effect of a short animated educational video on knowledge among glaucoma patients, Al Owaifeer AM; Alrefaie SM; Alsawah ZM et al., Clinical Ophthalmology, 2018; 12: 805-810

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Improving patients' understanding of glaucoma is likely to enhance patient engagement and improve adherence to treatment, with the potential to lead to better outcomes.¹ Possible educational interventions include nurse-led education sessions, motivational interviewing, or the provision of materials such as written materials or educational videos. Al Owaifeer and colleagues assessed the effect of a short educational video on knowledge of glaucoma among 196 adults with glaucoma in Saudi Arabia. A previously validated 11-item questionnaire was used to assess knowledge of glaucoma before and after viewing a three-minute animated educational video. The video conveyed information including the nature of glaucoma, its effect on the optic nerve and vision, the necessity of regular follow up and the importance of treatment.

Following viewing of the video there was a significant improvement in knowledge score, rising from a mean (± standard deviation) of 6 ± 3.9 (range 0 to 16) to 11.1 ± 3.2 (range 3 to 17) out of a maximum score of 17. Following intervention almost two-thirds of patients had a knowledge score of 3≥11. Factors associated with greater knowledge included younger age, male gender, higher degree of education, higher income, family history of glaucoma and residence in an urban area.

The study encouragingly demonstrates that even a short educational intervention can improve patients' understanding of their disease. However, there are limitations and the results may not be generalizable to other populations. There was no control group and no long-term follow-up to determine if patients retained knowledge beyond the immediate post-intervention period. There is also the possibility that patients with poorest understanding of glaucoma may have elected not to participate in the study. In addition, the study did not compare different methods of education, so it is not clear whether other interventions may have been more effective than a three-minute video. An important observation is that almost 30% of participants were illiterate, which may have made an animated video of particular value for this group. However, the most effective method of education may vary between patients meaning an individualized approach is necessary.

Finding a cost-effective educational intervention and examining its effect on disease progression is therefore an important area for further research

Although the authors did not examine the potential benefits of improving patients' knowledge of glaucoma, Friedman and colleagues' Glaucoma Adherence and Persistency Study (GAPS) previously showed that patients who do not understand the goal of glaucoma treatment have lower adherence rates.² This finding is not universal, however, and it has even been suggested that knowing that glaucoma is a slowly progressive disease may be associated with lower adherence to medication.³ A 2013 Cochrane Review identified seven studies investigating the role of patient education for improving adherence, however there was insufficient evidence to recommend a particular intervention and no studies examined cost effectiveness.⁴ Finding a cost-effective educational intervention and examining its effect on disease progression is therefore an important area for further research. Improved understanding of glaucoma is likely to help patients become more actively engaged in managing their disease and in making treatment decisions, helping to sustain motivation to continue treatment.^4,5

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