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O. O. Idowu, F. D. Ford, C. Cowan; Barriers to Compliance in Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3606.
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To profile the characteristics of patients with glaucoma presenting to a VA outpatient clinic to determine if unique barriers to adherence exist in this patient population.
A retrospective, cross-sectional study of 160 consecutive patients presenting to a VA outpatient clinic was conducted. Patients answered a questionnaire identifying factors that may represent contraindications for taking specific glaucoma medications. The surveys were reviewed; those patients actively taking glaucoma medications diagnosed with glaucoma or ocular hypertension were included for retrospective chart review. Data were analyzed for patient demographics, the type and number of other medical diagnoses, their compliance to therapy and the ease of control of their disease.
Of the 160 patients surveyed, 80 were taking glaucoma medications. Of these men accounted for 95% of patients. Mean age of partcipants was 72.75 years. Sixty-one (76.25%) were African American, 14 were white, 2 were Hawaiian Pacific and 3 patients unspecified. POAG was the commonest form of glaucoma (83%). Glaucoma patients had, on average, 3.3 other diagnoses. 73.75 had hypertension, 43.75% had diabetes mellitus, 23.7% had coronary artery disease, and 13.75% had respiratory disease. Twenty-one (26.25)% had documented noncompliance in the medical record. All of them were male. Nineteen (90.48%) had primary open angle glaucoma. Sixteen (79.19%) were on two glaucoma eye drops or less and only one (4.76%) had more than three eye drops. Seven (33.33%) had advanced or uncontrolled glaucoma while four (19.05%) had mild glaucoma. Of the noncompliant patients, nine (42.85%) had a psychiatric illness. Younger patients showed a greater tendency to noncompliance with nine (42.85%) younger than sixty-five. All of the patients who were noncompliant had two or more comorbidities with nine (38.10%) of them having five or more comorbidities. Nine (42.85%) of the noncompliant patients were on three or more systemic medications and eight (38.10%) were dead within five years of the survey.
Previous studies have shown that compliance declines with increasing number of drops and that cost of glaucoma therapy is a major issue affecting compliance for many patients. In this majority male population with no economic barriers to medication procurement, we found that younger age, psychiatric illness, increasing comorbidities and being on systemic medications were linked to noncompliance. We did not find that a higher number of drops correlated with noncompliance as many of those patients were on two drops or less.
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