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Meredith Remmer Klifto, Gabriella M Riley, Jennifer L Barger, Dan Ariely, Joel S Schuman; Use of a Smartphone Application to Analyze and Incentivize Glaucoma Medication Adherence. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5051.
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© ARVO (1962-2015); The Authors (2016-present)
Glaucoma is the 2nd leading cause of irreversible blindness, and eye drop adherence rates are around 50%. Recent studies have shown that glaucoma patients have interest in using a free application to aid adherence. The purpose of this study is to investigate the demographics of patients interested in a behavioral economics based smartphone app developed by NYU Ophthalmology, Duke University, and Pattern Health, and measure their drop adherence, satisfaction and intraocular pressure during the study.
After IRB-approved informed consent, patients with primary open angle glaucoma on at least two drops downloaded the app, and their glaucoma regimen was entered. Reminders were sent by push notifications and patients indicated adherence within the app. A virtual pet “Virgil the Turtle” was used to motivate adherence - the pet was happy with good adherence, but was despondent when users did not respond. Intraocular pressure was measured every 2-4 weeks. Post-study surveys are to be given at the study conclusion.
5 of an expected 25 patients have entered the study. Mean age was 70.4 years (SD+13.2, range 57-85), 60% were Caucasian, and 3 were male. The most common reason for not enrolling was difficulty attending IOP checks. Of those refusing enrollment, average age was 70.9 (SD+13). 52% were male and 78% were Caucasian.In pre-study surveys, average expected experience using the app was 7.6 out of 10, SD +2.6 (range 4-10, 10 most positive). Average predicted drop adherence during the study was 9.2, SD +1.3, (range 7-10) vs pre-study, subjective adherence of 8, SD+ 1.6 (range 6-10). Patients rated their expected increase in compliance as a result of Virgil the turtle to be 5.6, SD +4.3 (range 1-10). The patient with the best adherence (100%), was noted to have the best IOP reduction, at 26%. The patient with the lowest adherence (39%) was noted to have the highest IOP increase, at 20%.
Preliminary results suggest that a behavioral economics based smartphone app can enhance adherence, but Virgil the Turtle will play only a modest role. Comfort with the app was not dependent upon age. Better adherence as measured by the app was associated with improved IOP lowering. Future work aims to investigate alternate methods of motivation, and analyze long term adherence and IOP. Optimizing compliance can reduce costs and improve patient outcomes by avoiding expensive and invasive treatments.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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