Lifestyle Counseling for Medication Adherence in Glaucoma

Figures & data

Table 1 Lifestyle Counseling Intervention

Variable	Counseling Script
Medication Adherence	Continued encouragement of daily drop use Use drops before 7 AM if possible Use drops the same time everyday Wait at least 5 minutes between drops Match the timing of drops with meals, with use by 8–9 PM
Diet	Do you eat a balanced diet daily? Do you eat processed foods daily? Do you eat fast food daily? How many servings (1/2 cup) of fruit/vegetables do you eat per day?
Vitamin	What vitamins do you take?
Exercise	Do you exercise at least 30 min/day for ≥ 5 days a week?
Stress	Suggested stress reducing measures:  Exercise  Yoga  Meditation, deep breathing  Improving sleep patterns  Plant based diet (reducing processed, animal-based products)

Figure 1 Study flow diagram.

Table 2 Data Collection

Variable	Question	Analysis
Age	Retrieved from EMR	Mean (yr)
Race	Retrieved from EMR	White, Black, Other
Sex	Retrieved from EMR	Male Female
Education	Highest level of education?	High School or Less College or More
Employment Status	Employed/Unemployed/Retired/Disability/Homemaker	Unemployed Employed
Body Mass Index (BMI)	Retrieved from EMR	Mean (kg/m^2)
Family History of Glaucoma	Any family histories were noted	No Yes
Stress Level	Perceived Stress Scale (ref)	Mild Moderate Severe
Disease Category	Retrieved from EMR, one eye randomized	OHT Mild POAG Moderate POAG Severe POAG
Number of Prescribed Medications	Retrieved from EMR	1 2 3 or more
Medication Adherence	Does patient miss drops?	Yes – nonadherent No – Adherent

Table 3 Characteristics of Patient Population

Variables	Nonadherent	Adherent	p
	N=47 (40.5%)	N=69 (59.5%)
Age, yr mean	68 ± 11.7	67 ±10.9	0.77
Race
White	17 (36.2)	33 (47.8)	0.46
Black	19 (40.4)	23 (33.3)
Other	11 (23.4)	13 (18.8)
Sex
Male	23 (48.9)	33 (48.5)	1.00
Female	24 (51.1)	35 (51.5)
Education
High School or Less	13 (27.7)	21 (30.4)	0.91
College or More	34 (72.3)	48 (69.6)
Employment
Unemployed	21 (44.7)	36 (52.2)	0.55
Employed	26 (55.3)	33 (47.8)
BMI, kg/m^2 mean	28 ±5.7	29 ± 6.9	0.31
Family Hx of Glaucoma
No	20 (42.6)	24 (34.8)	0.51
Yes	27 (57.4)	45 (65.2)
Stress Level
Mild	36 (78.3)	46 (73.0)	0.69
Moderate	10 (21.7)	17 (27.0)
Disease category
OHT	19 (40.4)	14 (20.3)	0.13
Mild POAG	10 (21.3)	18 (26.1)
Moderate POAG	13 (27.7)	26 (37.7)
Severe POAG	5 (10.6)	11 (15.9)
Number of Prescribed Medications
1	18 (38.3)	27 (39.1)	0.95
2	17 (36.2)	23 (33.3)
3 or more	12 (25.5)	19 (27.5)

Abbreviations: BMI, body mass index; POAG, primary open angle glaucoma; OHT, ocular hypertension.

Table 4 Fisher’s Exact Test for Independence Adherence by Disease Category

Contingency Table
Variable		OHT	Mild POAG	Moderate POAG	Severe POAG
		N=33 (%)	N=28 (%)	N=39 (%)	N=16 (%)
Adherence	Yes	14 (42.4)	18 (64.3)	26 (66.7)	11 (68.7)
	No	19 (57.6)	10 (35.7)	13 (33.3)	5 (31.3)
Fisher’s Exact Test		p-value = 0.142
Cochran Armitage Trend Test		z-statistic = −1.916 p-value = 0.055

Abbreviations: OHT, ocular hypertension; POAG, primary open angle glaucoma.

Table 5 Logistic Regression Results

	Adherence
	OR	95% CI
N=107*
Age, yr	0.97	(0.92,	1.01)
Race, Other^†
White	2.10	(0.69,	6.54)
Black	1.05	(0.32,	3.46)
Sex, Male^†
Female	0.96	(0.38,	2.41)
Education, High School or Less^†
College or more	0.79	(0.28,	2.15)
Employment, Unemployed^†
Employed	0.68	(0.25,	1.82)
BMI, kg/m^2	1.05	(0.98,	1.13)
Family Hx, No Hx of Glaucoma^†
Hx of Glaucoma	1.43	(0.59,	3.50)
Stress Level, Mild Stress^†
Moderate Stress	1.53	(0.56,	4.35)
Disease Category, OHT^†
Mild POAG	2.38	(0.76,	7.86)
Moderate POAG	4.14	(1.33,	14.24)
Severe POAG	6.42	(1.28,	37.67)
Number of Prescribed medications, 1^†
2 medications	0.66	(0.23,	1.82)
3 or more medications	0.53	(0.15,	1.75)

Notes: *n=9 with missing covariate values were dropped from analysis. ^†Reference category

Abbreviations: OR, adjusted odds ratio; OHT, ocular hypertension; POAG, primary open angle glaucoma; BMI, body mass index; Hx, history.

Table 6 McNemar’s Test for Follow-Up Adherence

Contingency Table
Variable		Adherence at Second Encounter N=76 (%)
		Yes	No
Adherence at First Encounter N=76 (%)	Yes	43 (56.6)	5 (6.6)
	No	17 (22.4)	11 (14.5)
Became Noncompliant		5 (6.6%)
Became Compliant		17 (22.4%)
Odds Ratio		0.29 (0.085, 0.831)
p-value		0.017