Patient satisfaction with glaucoma therapy: reality or myth?

Abstract

While safe and effective treatments for glaucoma exist, their effectiveness is compromised by poor compliance. Patients who have problems with their topical glaucoma medication are acknowledged to be at higher risk for poor compliance, frequent medication switching, and surgery. Patient satisfaction with therapy and its associated benefits have until recently taken second place to efficacy. The present study is a transverse cross-sectional epidemiological survey among glaucoma patients receiving therapy with prostaglandin analogs. The primary objective was to determine and characterize patient satisfaction with glaucoma therapy, and the secondary objective was to identify factors that may contribute to poor patient satisfaction. Ophthalmologists in the Netherlands included 199 patients and 164 were analyzed. Patients were predominantly elderly with early, primary, open angle glaucoma. Eighty-nine percent of them stated they were satisfied or very satisfied with their treatment. However, signs of ocular surface disorder on ophthalmological examination were evident in 44% of patients, corneal fluorescein staining was positive in 28% of patients, and 38% of patients were using tear substitutes. The prevalence of blepharitis/meibomian gland dysfunction and dry eye was more than twice as high after the commencement of therapy compared with before therapy. Univariate analysis revealed that patient dissatisfaction with their glaucoma therapy was statistically significantly (P<0.001) associated with the presence of ocular surface disease, hyperemia, ocular signs, symptoms upon and between instillation, and the use of tear substitutes. Apparently, patients in the present study are satisfied with their treatment; 89% expressed satisfaction compared with only 11% who professed dissatisfaction. The results suggest that even if local adverse events and ocular surface disease, in particular, contribute to glaucoma patient dissatisfaction, only a minority of patients expressed such dissatisfaction. At the time of the study, most (94%) of the patients included were receiving preserved preparations. Further studies should evaluate the influence of preservative on patient satisfaction.

Keywords:

• prostaglandin analogs
• cross-sectional study
• compliance
• adherence
• ocular surface disease
• dry eye
• meibomian gland dysfunction

Acknowledgments

The GOAL (glaucoma patients treated with prostaglandins satisfaction evaluation) Study Netherlands investigators comprised the following:

NAM Bemelmans, St Elisabeth Ziekenhuis, Tilburg, the Netherlands; PSJR Crobach, Laurentius Ziekenhuis, Roermond, the Netherlands; LP Cruysbergh, Heerlen, the Netherlands; PS Edelbroek-Hoogendoorn, Ziekenhuis Rivierenland, Tiel, the Netherlands; F Hageman, OPSIS Oogziekenhuis Amstelveen, Amstelveen, the Netherlands; JGMM Hoevenaars, VieCuri – Medisch Centrum, Venlo, the Netherlands; CF Hommersom, Máxima Medisch Centrum, Veldhoven, the Netherlands; LS Koetsier, Leids Universitair Medisch Centrum, Leiden, the Netherlands; H Lemij, Rotterdam Eye Hospital, Rotterdam, the Netherlands; ILA Liempt, Amphia Ziekenhuis, Breda, the Netherlands; W Maat, Maasstad Ziekenhuis, Rotterdam, the Netherlands; RCM Maatman, Maasstad Ziekenhuis, Leiderdorp, the Netherlands; K van der Maesen, Oogziekenhuis Zonnestraal OMC Haarlem, Haarlem, the Netherlands; JAW Metzelaar-Blok, Albert Schweitzer ziekenhuis, Zwijndrecht, the Netherlands; LJ Noordzij, VieCuri – Medisch Centrum, Venlo, the Netherlands; H van Santbrink-Bakker, Rijnland Ziekenhuis, Leiderdorp, the Netherlands; TL van der Shaft, Maasziekenhuis Pantein, Beugen, the Netherlands; W Swart, Leids Universitair Medisch Centrum, Leiden, the Netherlands; S Tecim, Tergooi, Blaricum, the Netherlands; UF Tegelberg, Admiraal De Ruyter Ziekenhuis, Goes, the Netherlands; CJG Van Tilburg, Vlietland Ziekenhuis, Schiedam, the Netherlands; and C van der Windt, Ziekenhuis Rivierenland, Tiel, the Netherlands.

The study was funded by Laboratoires Théa. Dr JF Stolz assisted with the preparation of the manuscript. This assistance was funded by Laboratoires Théa.

Disclosure

Dr Baudoin reports consultancies and research grants with and from Alcon, Allergan, Santen and Thea. Dr Hoevenaars once received a research grant from Thea. The authors report no other conflicts of interest in this work.