White coat adherence in primary open-angle glaucoma

Abstract

Purpose : Improved adherence to treatment in the days surrounding clinic visits is a phenomenon known as white coat adherence. White coat adherence can lead to clinical measurements that are not representative of those present outside of clinical encounters. In glaucoma, white coat adherence to prescribed hypotensive therapy may lead to artificially low intraocular pressure readings, which may impact clinical evaluation and treatment decisions. The objective of this study was to assess white coat adherence in glaucoma patients.

Methods : In this cohort study, patients with primary open-angle glaucoma were selected from an ongoing longitudinal NIH-funded study if they used hypotensive eyedrops, had a clinic visit during the parent study, and had adherence data during the 56 days evenly bracketing the clinic visit. Adherence within the implementation phase was measured using Medication Event Monitoring System (MEMS) caps. Wilcoxon tests were used to compare mean adherence between the following periods: Pre_1-3 (days 1 to 3 preceding the clinic visit) and Pre_4-14 (days 4 to 14 preceding the clinic visit; Post_1-3 (days 1 to 3 following the clinic visit) and Post_4-14 (days 4 to 14 following the clinic visit). Analyses were performed in the full sample, and in patients with optimal (≥80%, n = 48) and suboptimal adherence (<80%, n = 17).

Results : Sixty-five patients were included, of which 47.7% were male. Mean age was 71 ± 8 years. In the six months bracketing the clinic visit, mean adherence was 86.1% ± 17.9. Overall, mean adherence significantly increased from Pre_4-14 to Pre_1-3 (85.2% to 88.3%) (p = 0.04). No significant change was observed after the clinic visit. In patients with optimal adherence, mean adherence significantly increased from Pre_4-14 to Pre_1-3 (93.8% to 97.7%) (p = 0.01), whereas no significant change was observed in patients with suboptimal adherence.

Conclusions : Our results show the presence of white coat adherence in this cohort of patients. However, this effect was not observed in patients with suboptimal adherence. Due to its potential impact on treatment decisions, providers should remain vigilant for white coat adherence and make this a relevant topic in patient-provider discussions.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.