Do not change glaucoma therapy in a progressing patient until you can exclude non-adherence to the prescribed therapy as the reason for progression

Science behind the tip:

Glaucoma management is challenging and one of the most important tasks is keeping your glaucoma patient adherent to the therapy you prescribed.

As in many chronic diseases, adherence is not very high in glaucoma and has not improved despite several attempts to influence it. Many domains can influence adherence, among them knowledge, skills, memory and environmental context (1). It is still unclear if multifaceted attempts to improve adherence are successful (2), however it seems that adherence in the first years of treatment may be a good predictor for future adherence (3).

If a patient progresses under therapy, you should consider non-adherence among other reasons before changing to a more invasive therapy. When you address adherence, it is essential to avoid “yes” or “no” questions. Especially in elderly patients with cognitive or systemic disorders (4) which may reduce adherence it is important to include the patient’s surrounding helpers in the application of the therapy.

References

1) Bott D, Subramanian A, Edgar D, Lawrenson JG, Campbell P. Barriers and enablers to medication adherence in glaucoma: A systematic review of modifiable factors using the Theoretical Domains Framework. Ophthalmic Physiol Opt. 2024 Jan;44(1):96-114. doi: 10.1111/opo.13245. Epub 2023 Nov 20. PMID: 37985237. 2) Kruoch Z, Amin P, Shelton E, Zimmerman AB, Stephey E, Hunter M, Downie LE, Qureshi R. Multifaceted behavioral interventions to improve topical glaucoma therapy adherence in adults. Cochrane Database Syst Rev. 2025 Jun 11;6(6):CD015788. doi: 10.1002/14651858.CD015788.pub2. PMID: 40497459; PMCID: PMC12153040. 3) Kolko M, Faergemann Hansen R, G Dal L, Sabelström E, Brandel M, Hoiberg Bentsen A, Falch-Joergensen AC. Predictors and long-term patterns of medication adherence to glaucoma treatment in Denmark-an observational registry study of 30 100 Danish patients with glaucoma. BMJ Open Ophthalmol. 2024 Apr 15;9(1):e001607. doi: 10.1136/bmjophth-2023-001607. PMID: 38626933; PMCID: PMC11029215. 4) Hou CH, Pu C. Long-Term Effect of Systemic Comorbidity on Glaucoma Medication Adherence. Am J Ophthalmol. 2024 May;261:132-140. doi: 10.1016/j.ajo.2024.01.019. Epub 2024 Jan 24. PMID: 38278203.

Contributor: Frances Meier-Gibbons, Eye Center Rapperswil, Rapperswil, Switzerland

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