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Editors Selection IGR 7-1

Adherence: Dosing aid

Comment by Anastasios Konstas on:

21680 The effect of selective laser trabeculoplasty on intraocular pressure in patients with intravitreal steroid-induced elevated intraocular pressure, Rubin B; Taglienti A; Rothman RF et al., Journal of Glaucoma, 2008; 17: 287-292

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Do we really know if our glaucoma patients use their glaucoma medications as prescribed? Unfortunately in many cases we do not. Cumulative evidence suggests that between 27-59% of glaucoma patients do not do what we the ophthalmologists have asked them to do by prescribing a medication to lower their intraocular pressure. Further, we often can not predict who amongst our patients will adhere to our therapies. Recent evidence by Stein et al. (Ophthalmology 2008; 115: 1315-1319) is alarming, since more than one quarter of patients in that study did not receive anti-glaucoma therapy at all. Consequently, it is important to determine and understand the limitations to glaucoma therapy and explore ways to enhance the rate of adherence. Objective monitoring is a key driver in establishing the real barriers to glaucoma therapy and then validating interventions to enhance adherence. Hollo and Kothy (1220) employed the Travalert Dosing Aid (TDA) to measure objectively the adherence of a group of patients treated with travoprost drops given once in the evening. They then tested the value of the audible alarm function of the TDA device, addressing the question whether this alarm will improve the rate of adherence of their patients. The authors enrolled 39 well-controlled glaucoma patients who have been using travoprost for a mean period of 17.7 months. In the first three-month period, they monitored their patients with the TDA without activation of the audible alarm. Adherence to travoprost therapy was found to be 81.6%. Following the activation of the alarm function in the second period of the study, adherence to travoprost therapy was further significantly improved to 85.3%. An important finding of this study was the negative correlation between the improvement in adherence and the number of daily instillations. Thus, this important study demonstrates the clinical utility of the audible reminder in the TDA device since it improves adherence in patients using once-a-day prostaglandin therapy. Further studies are needed to test general applicability bearing in mind the fact that the patients on this study were a selected group with better than average adherence since they were already well-controlled on travoprost monotherapy. Objective monitoring of glaucoma therapy and active interventions aiming at improving adherence may significantly improve the prognosis of glaucoma in the future.

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