Uncovering obstacles yields strategies for improving adherence

Ophthalmologists need to recognize that there are many obstacles to glaucoma medication adherence before starting a dialogue with patients to identify barriers specific to individuals and strategies for overcoming them, said Robert D. Fechtner, MD, professor of ophthalmology and director, glaucoma division, New Jersey Medical School-UDMNJ, Newark.

“Understand that patients won’t always use their glaucoma medications as directed, and they need to be educated that they have the ability to control their disease,” Dr. Fechtner said,

Identifying the individual who is non-adherent can be difficult because medication use may improve immediately before a scheduled visit and IOP will appear to be controlled, he said. Certain strategies can enable detection of patients with adherence problems.

Patients may be asked to name their medication, its appearance, and when it was last refilled. They should be able to tell what times of the day they use their medications and may be asked to demonstrate with a bottle of artificial tears how they instill their drops.

In exploring adherence, physicians also should formulate questions in a framework that gives patients permission to tell the truth.

“Tell the patient you understand there are obstacles to using medications, that most patients have some difficulties and forget a few times a week, and then ask what problems they have and how many times they forgot this week,” Dr. Fechtner explained.