Unless patients experience glaucoma symptoms, they often have trouble believing they need to use eye drops. Thankfully, disease progression is slow, and it may take years for a patient with uncontrolled glaucoma to lose vision. Eventually, however, worsening disease will permanently affect vision. My goal is to impress upon patients why they must use their drops consistently from the day they are prescribed. This article shares five strategies that I have found help improve adherence.
No. 1. POSITIVE REINFORCEMENT
During every visit, I spend a few minutes praising patients if their IOP is in the targeted range. I emphasize that they are doing a great job and that I can tell they are using the drops. In my experience, positive reinforcement goes a long way in instilling hope, and it encourages patients to be active participants in their care plan.
No. 2. OWNERSHIP AND PARTNERSHIP
I talk with patients about why they need to continue to administer medical therapy as prescribed and take ownership of their treatment. I emphasize that it is their responsibility to follow through on the care plan. I also stress that my relationship with them is a partnership and that I will monitor their disease, provided they follow the treatment course and keep their appointments. Ultimately, if patients do their part, then I can do mine.
No. 3. EDUCATION
I address what it means for patients to miss their eye drops 1 day a week. I explain that missing medication once per week adds up to 48 days per year, which is almost 6 weeks annually with no treatment. I find that these terms make an impression on many patients.
I provide 1-page, easy-to-read handouts that cover basic information about glaucoma and how to administer eye drops. For Internet-savvy patients, I recommend Allergan's website, Lumigan.com. It provides information on glaucoma, how to use eye drops, financial assistance for medications, and other useful tools. Patients can download an app for reminders on when to take drops.
No. 4. REEDUCATION
If I see that patients are not adhering to therapy, I spend time reeducating them about glaucoma. I show them the results of their visual field tests and other examinations so that they feel a part of the whole process. I find that including patients in this way encourages them to take ownership of their treatment.
No. 5. CREATIVITY
I help patients tie their dosing schedule to daily activities. For example, I encourage patients to instill their eye drops when they brush their teeth or wash their face. After a month or so of using eye drops, it becomes a part of their normal routine.
CONCLUSION
It is imperative to talk with patients about the state and stage of their glaucoma and help them understand their treatment plan. Doing so will lead to higher compliance and less chance of vision loss from glaucoma. n
Fiaz Zaman, MD, is a glaucoma specialist at Houston Eye Associates in Texas. He acknowledged no financial interest in the product or company mentioned herein. Dr. Zaman may be reached at fiazzaman@gmail.com.
