terminology and guidelines for glaucoma ii - Kwaliteitskoepel

3.4 - COMPLIANCE IN GLAUCOMA
Since glaucoma is a long-standing, progressive disease, which frequently requires topical medication and regular follow-up
appointments, a patient’s continuous co-operation is essential for successful management.
Compliance with glaucoma medications is considerably less than presumed by doctors and many patients fail to
attend follow-up appointments 26-30 . Non-compliance is likely to have an important role in the progression to blindness
from glaucoma 77 . Glaucoma patients are frequently old and may have diminished cognitive abilities, poor hearing
and other ailments which, like arthritis, may reduce their ability to actually administer medication.
Drug interactions and diminished drug tolerance must be taken into consideration. Consultation with other medical
practitioners involved in the patient’s care may be necessary 23,75 .
Compliance issues must be taken into account when the type of treatment is selected.
Poor compliance is summarized as follows:
1. Failure to instill eye drops (including ineffective technique of self-administration)
2. Excessive use of eye drops (extra drops may cause systemic side effects)
3. Self-administration of non-prescribed eye drops
4. Improper timing of eye drops and eye drop administration for wrong reasons (a more frequent problem if nume
rous drops are to be instilled and after changes in the patient’s topical medication regimen)
How can compliance be improved
1. Make the patient an active and informed participant in his/her management. Glaucoma itself and the mechanism
of the medication prescribed have to be explained. In addition, patients must be informed about the symptoms of
potential side effects. Written and audio-visual information can be added to verbal education. If necessary, com
munication with the patient’s family often helps to improve compliance.
2. The number, concentration of drug and frequency should be kept to a minimum. Ocular irritation may be
decreased by reducing the number of preserved eye drops 33-35 .
3. Inconvenience caused by the medication has to be minimised, and the times of the eye drop instillation should be
linked to landmarks of the patient’s daily routine.
4. The patient should be taught how to instill eye drops correctly (correct technique of instillation, lid closure, punctal
occlusion, use of instillation frames, time interval between administration of different drops etc). This knowledge
is to be checked in practice. Ancillary medical staff can significantly help to accomplish this work.
Ch. 3 - 27 EGS