Barriers to adherence with glaucoma medications: a qualitative research study

Abstract

Purpose: Glaucoma is initially asymptomatic, but untreated can result in progressive visual field loss and eventual blindness. With adequate therapy progression can be halted, but poor adherence with medical therapy is a significant issue requiring further research. The aim of the present study was to gain a better understanding of the obstacles to, and the motivations for, adherence with glaucoma medication and explore potential methods to improve adherence.

Methods: Participants had moderate/severe glaucoma diagnosed for >1 year, had seen >or=2 NHS ophthalmologists, and were prescribed >or=2 topical medications. Qualitative methodology was utilized to investigate aspects of adherence. Recruited patients either attended a focus group or had a home-based semi-structured interview. The transcripts were member-checked and the resulting data were analysed using 'Framework' analysis. The analysis was verified by a co-investigator and NVIVO Software was used to check data reliability.

Results: Multiple obstacles to adherence were identified, including poor education, lack of motivation, forgetfulness, drop application, and other practical issues, together with specific individual and age differences. Motivation for adherence was determined by fear of blindness and a faith in drop efficacy.

Conclusions: Specific obstacles to adherence with anti-glaucomatous therapy should be identified as early as possible after diagnosis. A tailored approach to patient care with initial education about the consequences of non-adherence and longer-term feedback about drop efficacy may improve patients' motivations for adherence. Future research should focus on investigating methods by which initial education about glaucoma and its management should best be delivered to patients.