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L. E. O'Dell, A. L. Robin; Determining Barriers to and Trends in Patient Adherence with Glaucoma Medial Therapy Using the TravatanTM Dosing Aid (TDA). Invest. Ophthalmol. Vis. Sci. 2007;48(13):5575.
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The TravatanTM Dosing Aid (TDA) is the first commercially available device designed to both aid in patients' adherence to their glaucoma therapies and records patients’ drop administration enabling doctors to better assess adherence. The TDA uses audible and visual clues reminding patients to use medications. It records the time, date and number of drops instilled. No prior studies have objectively evaluated adherence to glaucoma medications and its relationships to the severity of glaucoma or the use of prostaglandin analogues and multiple glaucoma medications.
We enrolled 100 consecutive subjects from the private practice of a glaucoma specialist, all currently using topical travoprost 0.004% (T). We issued a TDA to each subject to record both the time and date of each administered drop. All subjects gave informed consents and were aware that the medication’s use was monitored. Patients returned for follow up 30 to 60 days after the initial exam.
: 83 subjects completed the study (58 Caucasian, 20 African American, 5 other). 44 were men. The mean age was 71 years. 55.4% of the patients used monotherapy (T) and 44.6% also used an adjunctive therapy. Overall, patient adherence was 80% (range 22-100%). The mean rate of adherence for the 7 days prior to the scheduled follow-up exam was 74.0% improving to 85.5% the day prior to a follow-up visit. There was a marked association between the number of systemic medications the patients were using and patient adherence with T, 83.0% +/- 19.8 for patients using 5 or more (5-14) systemic medications had and 73.2% +/- 23.3 rate for patients using 4 or less systemic medications. When comparing adherence to perimetric average mean deviation, subjects with more severe glaucoma had better adherence, 80.4% +/-19.6 with mean MD of -11.3+/- 5.3 versus 72.5%+/-10.6 with a mean MD of -1.5 +/-2.0. Improved adherence was found in subjects using adjunctive therapy that was once daily dosing (81.1% +/- 25.0) versus patients using twice daily dosing (75.5% +/- 21.5).
Adherence to glaucoma medical therapy is a major barrier in the management and treatment of glaucoma patients given the chronic nature and the asymptomatic course of the disease. Until recently, an objective tool has not been available to the clinician to identify individual patients’ adherence. The TDA is an accurate tool that assesses adherence on an individual level. The clinician can now identify patients with poor adherence and counsel them, helping improve adherence and subsequently treatment outcomes.
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