The objective of a systematic review «Waterman H, Evans JR, Gray TA ym. Interventions fo...»1 was to summarise the effects of interventions for improving adherence to ocular hypotensive therapy in people with ocular hypertension (OHT) or glaucoma. Search by June 2012 included CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, PsycEXTRA, Web of Science, ZETOC, OpenGrey, mRCT, ClinicalTrials.gov, and ICTRP. RCTs and quasi-RCTs that compared interventions to improve adherence to ocular hypotensive.
Sixteen trials (1565 participants) met the inclusion criteria. Seven studies investigated some form of patient education. In six of these studies this education was combined with other behavioural change interventions including tailoring daily routines to promote adherence to eye drops. Eight studies compared different drug regimens (one of these trials also compared open and masked monitoring) and one study investigated a reminder device. The studies were of variable quality and some were at considerable risk of bias; in general, the length of follow-up was short at less than six months with only two studies following up to 12 months.
As different interventions and outcomes were reported, it was not possible to produce an overall estimate of effect. There was some evidence from three studies that education combined with personalised interventions, that is, more complex interventions, improved adherence to ocular hypotensive therapy. There was weak evidence as to whether people on simpler drug regimens were more likely to adhere and persist with their ocular hypotensive therapy. A particular problem was the interpretation of cross-over studies, which in general were not reported correctly. One study investigated a reminder device and monitoring but the study was small and inconclusive.
Authors’ conclusion: Although complex interventions consisting of patient education combined with personalised behavioural change interventions, including tailoring daily routines to promote adherence to eye drops, may improve adherence to glaucoma medication, overall there is insufficient evidence to recommend a particular intervention.
Adherence to prescribed glaucoma medications is often poor, and proper adherence can be challenging for patients. Systematic review of the literature «Newman-Casey PA, Weizer JS, Heisler M ym. Systemat...»2 identified 8 studies using educational interventions to improve glaucoma medication adherence. Overall, five of the eight studies found that educational interventions lead to a significant improvement in medication adherence, and two additional studies found a trend towards improvement. More rigorous studies grounded in Health Behavior Theory with adequately powered samples and longer follow-up are needed.