Rates of Treatment Compliance in Patients With Primary Open-Angle Glaucoma

Rod Foroozan, MD


October 01, 2008


Chronic conditions, including glaucoma, are often associated with high rates of poor treatment compliance. Prior studies have suggested that adherence to treatment recommendations is inadequate in patients with glaucoma.[1] The study authors of this longitudinal, observational study used data from the Medicare Current Beneficiary Survey (MCBS) to calculate the percentage of beneficiaries with primary open-angle glaucoma treated medically or surgically. They also determined the rate of utilization of glaucoma medications and attempted to determine the factors that may influence treatment modalities.

Rates of Glaucoma Medication Utilization Among Persons With Primary Open-Angle Glaucoma, 1992 to 2002

Stein JD, Ayyagari P, Sloan FA, Lee PP
Ophthalmology. 2008;115:1315-1319, 1319.e1


Using Medicare claims, the records of patients 65 years and older with a history of glaucoma (6446 patients) were reviewed. Rates of medical and surgical treatment for glaucoma were determined from 1992 to 2002. During this time period, 27% of patients with glaucoma received no treatment; this nontreatment rate increased by 3% each year. Patients with Medicaid and those of Hispanic and Asian ethnicity were more likely (43%) to be untreated. The use of beta-blockers and miotic agents decreased, whereas use of prostaglandins, alpha-agonists, and combination agents increased.


Despite the increasing evidence that lowering intraocular pressure is helpful in patients with glaucoma, more than one quarter of patients in this study did not receive treatment. In addition, the nontreatment rate increased by an alarming 3% per year. Unfortunately, the high rates of nontreatment are in accordance with other studies of glaucoma. An expected finding was the reduced use of beta-blockers and miotics in the treatment of glaucoma. The efficacy of the prostaglandins, which also have less frequent dosing, has led to the more frequent use of these medications.[2] The study authors emphasized that it is important to understand the limitations and barriers of treatment of glaucoma in order to improve the rates of compliance.



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