Editors Selection (IGR: 13-4) | International Glaucoma Review #41

Editors Selection IGR 13-4

Medical treatment: Treatment variations

Comment by Louis Cantor on:

13067 Persistence and adherence with topical glaucoma therapy, Nordstrom BL; Friedman DS; Mozaffari E et al., American Journal of Ophthalmology, 2005; 140: 598-606

Nordstrom et al. (1070) present a retrospective cohort study, suggesting that persistence and adherence with topical glaucoma therapy is poor. The authors analyzed individuals newly diagnosed with glaucoma or glaucoma suspect based on claims data from the INGENIX database, which includes prescription information from approximately eight million members of United Healthcare. The authors used liberal definitions for adherence and persistence to therapy, allowing for long periods of treatment use from each bottle of medication. Nearly one-half of all individuals who had filled a glaucoma prescription, discontinued ocular hypertensive therapy within 60 months. Just over one-third were still refilling their initial medication after three years. Of the medications evaluated, persistence with therapy, though poor overall, was better with prostaglandin analogues than with other classes of medications. Only 10% of the patients had refilled their topical medications without any gaps in therapy over a three year period.

Only 10% of the patients had refilled their topical medications without any gaps in therapy over a three year period

The authors acknowledge several potential limitations of their analysis. This was a retrospective cohort study based entirely on health insurance claims data dependent upon physician coding which was not validated through medical record review. The authors could not take into account use of sample medications nor account for patients that may have had other insurance that may have provided a portion of their medication refills. Utilizing refill data does not assure that the patient actually used the medication. A small percent of patients had laser or surgical treatment during follow up which may have appropriately led to discontinuation of topical medical therapy. Utilizing newly diagnosed patients may yield different conclusions from patients on chronic therapy.

Despite these limitations, the authors provide further data that many patients fail topical glaucoma medical therapy. The authors encourage the development of novel approaches to glaucoma therapy to improve on the persistence and adherence with glaucoma therapy.

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Issue 13-4

Table of Contents Editor's Selection