Multifaceted behavioral interventions may increase medication adherence in glaucoma: systematic review & metaanalysis

Abstract

Purpose : Glaucoma (glc) is a progressive blinding disease. Often, first line management is topical hypotensive therapy (THT). Non-adherence to THT decreases effectiveness and increases risk of disease progression. Several behavioral modifications have been suggested to improve THT adherence, but no method is singularly best. We sought to assess the impact of multifaceted on THT adherence in people using THT for ≥3 months prior to intervention for ocular hypertension (OHT) or glc.

Methods : We conducted a Cochrane systematic review following a published protocol. In May 2023, 8 bibliographic databases and 2 trial registries were searched. The review included randomized controlled trials (RCTs) of multifaceted interventions in adults ≥18 years with OHT or glc using THT. Outcomes of interest included change in percent adherence from baseline, IOP, disease stability, quality of life, and harms. Titles/abstracts and relevant full-text records were independently dual-screened using Covidence. Data were extracted independently by the review authors. Screening and extraction discrepancies were resolved with a third author.

Results : After retrieving 14205 records, 3015 duplicates were removed, and 11045 and 87 citations were excluded at title/abstract and full-text screening, respectively. Eight studies were ongoing and 12 awaiting classification, leaving 38 records of 19 studies (Figure 1). Studies involved 66 to 1800 participants (mean = 318), with a mean age of 65 years. Most interventions (n=15) included an educational component, followed by increased communication (n=13) and reminder systems (n=9). Most (n=15) comparators were standard care alone or with a second component. The heterogeneity of the specific interventions and ways of measuring endpoints precluded meta-analyses for most outcomes. A comparison of multifaceted interventions that include education versus standard of care using a standardized mean difference and random effects model, found evidence of a significant increase in adherence (Hedges g = 1.52 [95% CI 0.07, 2.96], I2 = 98%) (Figure 2).

Conclusions : There is some evidence that multifaceted interventions improve adherence to THT in people with glc. Lack of standards for measuring adherence challenged inter-intervention comparisons. Glaucoma RCTs should follow core outcome sets to optimize outcome collection.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

PRISMA diagram

 

Standardized mean difference in percent adherence