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Ayumi Usui, Itaru Kimura, Yujin Mochizuki, Akira Murakami; Effect of "Drop Diary" on Patient Adherence to Topical Glaucoma Therapy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5010.
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Poor adherence is a major factor associated with failure of topical therapy in glaucoma. However measurement of adherence is complex, although various approaches are used to assess patients’ adherence to the treatment regimen. This study aimed to assess drug usage, and measure adherence to the drug regimen in glaucoma patients using a daily log, a "Drop Diary".
We distributed the "Drop Diary" to glaucoma patients receiving topical therapy at our Urayasu Hospital, and asked them to note daily drug usage and bring the diary on their next visit. We also asked them to fill in a questionnaire. Based on the data from 128 patients who brought their "Drop Diary", we summarized the number of glaucoma drop medication per day, number of doses per day, number of combined drop medication without glaucoma drop per day, and adherence rates, and assessed the results of the questionnaire. We detected an inter-group difference using Mann-Whitney-U test or Fisher’s exact probability test where applicable.
The mean dose adherence rate was 97.8 ±5.9%, and 48.4% of patients never missed a dose, based on their "Drop Diary" data. Patients under 60 years old patients had significantly lower compliance than those 60 years old or over (p=0.0095). The mean number of eye drops that patients were prescribed was 2.3±1.1. The rate of non-adherent patients who were supposed to use 2 or 3 drops was significantly higher than those prescribed single drop (p=0.048). Of the 128 cases, 44 used carbonic anhydrase inhibitor. 66% used brinzolamide twice a day, and 34% used dorzolamide which 3 times a day. The rate of non- adherent patients using brinzolamide was 41.4%, and that of those using dorzolamide was 53.3%. In patients using dorzolamide the missed dose was mostly at noon (78%). There was no significant difference in the dose adherence rates of glaucoma drops between patients who use only glaucoma drops and those who use drops not for glaucoma therapy but also for therapy for corneal condition, conjunctivitis, or asthenopia. The results of the questionnaire, showed that 51% of patients answered that their adherence was helped by keeping a log in their "Drop Diary"; 65% of patients answered the "Drop Diary" was convenient, and 46% of patients answered that it was useful.
Keeping a "Drop Diary" was useful for us to know adherence to topical therapy in glaucoma patients. In some cases of poor adherence, we have to consider a personal specific regimen, including combination drugs. "Drop Diary" is effective tool for glaucoma clinic.
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