June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
White coat adherence in primary open-angle glaucoma
Author Affiliations & Notes
  • Nouran Sabbagh
    Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Shervonne Poleon
    School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Lyne Racette
    Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Footnotes
    Commercial Relationships   Nouran Sabbagh None; Shervonne Poleon None; Lyne Racette Olleyes, Inc., Code C (Consultant/Contractor)
  • Footnotes
    Support  NIH Grant EY025756; NIH Grant EY003039; Unrestricted grant from Research to Prevent Blindness
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 1648 – A0143. doi:
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      Nouran Sabbagh, Shervonne Poleon, Lyne Racette; White coat adherence in primary open-angle glaucoma. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1648 – A0143.

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      © ARVO (1962-2015); The Authors (2016-present)

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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: Pre1-3 (days 1 to 3 preceding the clinic visit) and Pre4-14 (days 4 to 14 preceding the clinic visit; Post1-3 (days 1 to 3 following the clinic visit) and Post4-14 (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 Pre4-14 to Pre1-3 (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 Pre4-14 to Pre1-3 (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.

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