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R. G. Carassa, P. Bettin, M. Fiori, C. Ciampi; Are Glaucoma Patients Reliable in Managing Their Therapy?. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5582.
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to verify adherence to the simplest topical therapeutic regimen in glaucoma, and to compare it with self reported frequency of administration.
we selected consecutive bilateral open-angle glaucoma patients on travoprost monotherapy coming for routine visits in our glacoma service, and gave them a miniaturized device (TravalertTM), recording date, time and number of drop instillations. Patients were told that the device was meant to help them squeeze the bottle and tried it in front of us until a correct use was achieved. They were asked to bring the device back 4 weeks later, when we downloaded the device data and administered them a questionnaire about scholarity, family status, help in putting the drops, factors impairing correct self-instillation, adverse events, and a self-estimate of the number of missed doses. To minimize biases, "missed dose" was the total absence of recorded dosing for over 36 hours.
22 patients were enrolled (mean age 61±13 years): 1 failed to return the device, the other 21 reported no problem in using it. 17/22 stated that they had administered "all" the doses, whereas 2/22 declared they had missed the drop "once or twice in a month": data analysis revealed that patients had missed 12.6% of the administrations. Among those who declared that they had always put their drops, one had a 58% missing rate, and 3 had missed over 33% of the doses. The 2 subjects who reported missing the drop "once or twice" had only a 6% and 12% missing rate. In the 3 days before the control visit the missing rate was 9.5%. Patients with lower scholarity level had a slightly higher rate of missed drops, attaining 15%, compared to 11.5% in the subgroup with higher scholarity (n.s.). 5 patients stated that were helped by another person in putting the drops, and these missed only 8% of the doses.
12.6% (range 0-58%) of the daily instillations of glaucoma monotherapy were missed. 19% of patients had a very poor adherence to therapy, with missing rates ranging from 33 to 58%. The patients’ statements about their adherence to prescription were unreliable. Higher scholarity was associated with a slightly better compliance. Help by another person can improve adherence, which also tends to increase slightly in the days preceding a control visit.
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