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Subspecialties Glaucoma

Glaucoma Adherence in Latin America

Credit: Headshot supplied by Ricardo Abe

Adherence to treatment in asymptomatic chronic diseases is a delicate matter. When it comes to glaucoma, research conservatively estimates that around 30 percent of patients will be non-adherent to treatment for various reasons, including forgetfulness, complexity of drug regimens, side-effects, insufficient disease awareness, and financial constraints.

In Latin America, previous studies have not explored treatment adherence rates using objective metrics with monitoring devices – nor have they correlated these rates with glaucoma progression and loss to follow-up. It was our goal, then, to implement a medication adherence monitoring system to accurately measure adherence rates and identify potential risk factors associated with poor adherence (1).

Our team first estimated the rate of glaucoma treatment adherence using medication monitoring devices in a group of patients. Though the rates of adherence were similar to previous studies from the US and Europe – around 28 percent non-adherence in our cohort of 110 patients, it is important to note that we didn’t assess instillation techniques to evaluate whether patients were using the medication properly. In fact, patients in clinical studies monitored with devices may show higher adherence rates. We can therefore presume that the actual rates of true adherence might be lower than the numbers reported for patients in a real-world scenario.

Our findings also discovered an association between the rates of adherence with glaucoma progression, loss to follow-up, and several other clinical variables. These factors include older age, low educational and income levels, lack of health insurance, and fewer years living with the disease.

We believe that, going forward, it would be useful to examine possible side effects and the cost of the medication, alongside the implementation of a family or friends support system to remind patients of their treatment regimen.

Healthcare providers must find solutions to minimize the risk of non-adherence to treatment. From an industry perspective, creating preservative-free glaucoma eye drops, offering cost-effective options, and expanding drug combination choices could mitigate the impact of poor adherence. On the clinician side, fostering stronger patient relationships to address concerns about glaucoma physiology and treatment necessity could promote greater treatment engagement.

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  1. L Oltramari, et al., “The association between glaucoma treatment adherence with disease progression and loss to follow-up,” Sci Rep, 25, 14(2024): DOI: 10.1038/s41598-024-52800-2.
About the Author
Ricardo Abe

Ophthalmologist at the Hospital Oftalmológico de Brasília.

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