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Harry Quigley (co-chair)In February, 2005 an WGA Committee on Cooperation with Glaucoma
Therapy was constituted (Quigley, Hitchings, Cantor, Friedman, Goldberg,
Gross, Kitazawa, Obstbaum, Halprin (Alcon), Taylor (Pfizer), Walt (Allergan)),
to evaluate what is known and what research should be done on
cooperation with medical therapy for glaucoma. Recent publica- Issues that seem immediately relevant to explaining poor patient cooperation with therapy are lack of symptoms, slow change in visual function, loss of quality of life only late in disease, poor patient understanding of the disorder, lack of adequate physician educational efforts, cost of medication, frequent dosage, and multi-drug regimens. The committee's work was divided into four phases. First, they have defined objectives, determined an interactive methodology, determined a time line, and generated a document on aims and methods (complete April, 2005). Second, they have assessed the complete published literature on patient cooperation with therapy for glaucoma and general medical diseases relevant to glaucoma (see www.worldglaucoma.org). They have defined terms related to poor cooperation (compliance, adherence, persistence) and summarized available data sources for information on cooperation (complete July, 2005). Remaining work includes identification of all potential risk factors for poor patient cooperation, specification of interventions for research studies that might improve cooperation with therapy, evaluation of methods to monitor cooperation in research protocols, and selection of various populations that would be useful for study of cooperation. The final stage is the development of research designs to be suggested to the glaucoma community (to be completed by December, 2005). Once these suggested protocols are written, it will be important for WGA to stimulate member organizations to carry out such research, to find funds to support the investigations, and to increase awareness of cooperation issues among ophthalmologists. See the WGA website for more information on this and other committees Addition from the Editor:In a recent (August) editorial in the Archives of Ophthalmology, Friedman et al. make a plea for a "more pro-active approach" in glaucoma care (Arch Ophthalmol 2005; 123: 1134-1135). They consider identification of glaucoma, retaining identified patients and continuation of taking eyedrops (adherence). The final 'SOLUTIONS' are reproduced here: "First, educational and behavioral interventions may improve patient cooperation, but only if they are shown to be cost-effective in present practice settings. Second, better office procedures to track prescription refilling or voluntary patient agreement to have pharmacy records accessed may identify poor adherence. With identification of these patients comes the possibility of introducing appropriate interventions to improve compliance. Electronic eyedrop dispensers that record when doses are taken could greatly assist in monitoring drug usage. The low cost and availability of microinstrumentation could make such devices part of every eyedrop bottle. Glaucoma care is more than checking visual fields, monitoring optic nerves, and writing prescriptions. As ophthalmologists, we need to recognize that the current system does not work for the majority of patients. To achieve the best outcome for glaucoma patients, we must improve on what we are presently doing. The current approach is failing to help glaucoma patients in an optimal way. We must take an active role in designing and testing new methods for the education of our patients and colleagues that will prevent vision loss from glaucoma more effectively." |
