Wolfram Christian, Stahlberg Erik, Pfeiffer Norbert
1 Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany.
2 Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Mainz, Germany.
J Ocul Pharmacol Ther. 2019 May;35(4):223-228. doi: 10.1089/jop.2018.0134. Epub 2019 Mar 21.
Effective glaucoma therapy relies to a great extent on the patients' ability to regularly self-administer eye drops. This study aimed to assess self-reported nonadherence and to identify potential barriers to adherence in glaucoma patients. Participants completed a 16-item questionnaire, designed to examine nonadherence rate and assess the therapy experience. Inclusion criteria stipulated treatment duration of at least 1 year. Nonadherence was defined as missing ≥5% of the prescribed pressure-lowering eye drops doses. In total, 201 glaucoma patients aged 24-88 years were included. Mean treatment duration was 9.4 years. Nonadherence was reported by 30.3% of participants and 69.7% were reported to be adherent. Individuals who experienced side effects reported higher levels of nonadherence than those who did not (37.6% vs. 18.4%; = 0.004). Eye drops with preservatives were used by 84.1% of participants, 11.9% were on combined preservative and preservative-free treatment, and 4.0% on preservative-free medication only. Self-reported nonadherence levels were 32.0%, 25.0%, and 12.5%, respectively, for each of these groups. Men reported higher rates of nonadherence than women (36.8% vs. 24.5%; = 0.066). Age, social status, history of migration, severity of disease, and fear of blindness were not associated with significant differences in nonadherence levels. Nonadherence with glaucoma therapy is a significant barrier to therapeutic success for approximately one-third of patients. Nonadherence may be reduced if side effects are avoided. Preservative-free products may provide adherence benefits. The patient experience should be a key consideration when selecting appropriate treatments, to reduce nonadherence and optimize outcomes.
有效的青光眼治疗在很大程度上依赖于患者定期自行滴眼药的能力。本研究旨在评估自我报告的不依从情况，并确定青光眼患者依从性的潜在障碍。参与者完成了一份16项问卷，旨在检查不依从率并评估治疗体验。纳入标准规定治疗持续时间至少为1年。不依从被定义为错过≥5%的规定降压滴眼药剂量。总共纳入了201名年龄在24 - 88岁的青光眼患者。平均治疗持续时间为9.4年。30.3%的参与者报告有不依从情况，69.7%的参与者报告依从。经历副作用的个体报告的不依从水平高于未经历副作用的个体（37.6%对18.4%；P = 0.004）。84.1%的参与者使用含防腐剂的滴眼药，11.9%的参与者接受含防腐剂和不含防腐剂的联合治疗，4.0%的参与者仅使用不含防腐剂的药物。这些组的自我报告不依从水平分别为32.0%、25.0%和12.5%。男性报告的不依从率高于女性（36.8%对24.5%；P = 0.066）。年龄、社会地位、移民史、疾病严重程度和对失明的恐惧与不依从水平的显著差异无关。青光眼治疗的不依从是大约三分之一患者治疗成功的重大障碍。如果避免副作用，不依从情况可能会减少。不含防腐剂的产品可能有助于提高依从性。在选择合适的治疗方法时，应将患者体验作为关键考虑因素，以减少不依从并优化治疗效果。
