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Editors Selection IGR 14-2

Cooperation with medical therapy: Adherence

Comment by Steve Mansberger on:

19905 Adherence in glaucoma: objective measurements of once-daily and adjunctive medication use, Robin AL; Novack GD; Covert DW et al., American Journal of Ophthalmology, 2007; 144: 533-540

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Robin et al. (1471) examine the adherence in glaucoma therapy using the MEMSCAP. This device provides an objective measure of compliance, and alerts subjects to the number of times a bottle had been opened during the current 24-hour period and how long it will be until their next dose. The study duration was 60 days and included a convenience sample of 62 adult patients. The investigators informed the subjects that they would be monitoring them for compliance with their glaucoma medications. The authors found that adherence to a once-a-day prostaglandin was good with 97% of subjects having less than fi ve errors over the 60-day period. However, the use of a second medication resulted in 37% of patients having more than five dosing errors over the 60-day period.

Adherence suffers when patients are prescribed

Overall, these results support earlier work that adherence suffers when patients are prescribed multiple medications. Also, their proportion of adherence is higher than previous studies using electronic monitoring or pharmacy records. The authors correctly point out that their measure of adherence may be overestimated since the patients were convenience samples from a private practice clinic and they were informed several times during the course of the study that they were being monitored. The natural clinical situation would be different. The authors may consider reexamining their data since it is likely the data is not normally distributed. Therefore, presenting the data as a mean as a ± deviation may not be appropriate. In any case, this will not change the main results of the study. Robin et al. presented an objected measure of compliance with glaucoma medications - a topic that has not been addressed for years. Hopefully investigators will develop an electronic monitor for all medications that does not require a bottle within a bottle mechanism. Further studies are needed to estimate the adherence of glaucoma patients.

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