Emerging glaucoma treatments: are we seeing an improvement in adherence?

ABSTRACT

Introduction

Nonadherence to glaucoma medication and poor follow-up is a global health concern.

Areas covered

Glaucoma remains one of the largest causes of irreversible blindness worldwide. Traditional treatment guidelines suggest topical eye drop medication as first-line therapy followed by addition of supplementary medications before proceeding to more invasive glaucoma surgeries. Unfortunately, poor glaucoma self-management remains high, leading to disease progression and blindness. Recent advancements in the field of pharmacotherapies, surgeries, and behavioral approaches have taken aim at increasing support for glaucoma self-management. We review the current and emerging approaches toward glaucoma management, with the exception of bleb-based surgical approaches, to investigate if they have had an impact on adherence. Literature searches were conducted via MEDLINE (PubMed), Embase (Elsevier), Cochrane Library (Wiley), and Preprints from 1 January 2018 to 26 January 2023.

Expert opinion

The ability to offer patients a multitude of choices enables patients to tailor their glaucoma treatment to their values and lifestyle. Offering personalized patient education and coaching to support chronic glaucoma self-management would better enable patient engagement in whichever treatment path is chosen. Currently, literature regarding the impact of these new advancements on treatment engagement is lacking; this field is ripe for additional intervention and assessment.

KEYWORDS:

• Hydrus
• glaucoma
• intracameral implants
• iStent
• latanoprostene bunod
• medication adherence
• microinvasive glaucoma surgery (MIGS)
• nanotechnology

Article highlights

• Nonadherence to glaucoma treatment remains high both in terms of low rates of medication utilization and low rates of returning for recommended follow-up care.

• Newer medical and surgical technologies aim to decrease medication burden by decreasing the number of daily administration times, but the impact on adherence to medication utilization and recommended follow-up care remains understudied.

• Eighty-nine percent of glaucoma patients use eye drops as treatment. Topical medications continue to play an important role in glaucoma management. Pharmacotherapies that combine medications to decrease dosing improve adherence.

• Minimally invasive glaucoma procedures can decrease the number of medications needed for disease control and offer patients more choices in how they prefer to manage their disease. To enhance the effectiveness of physicians’ care, a team-based approach to educating patients about their various options for controlling their glaucoma would likely enhance engagement in care. As glaucoma is a lifelong condition and these newer surgeries have only recently become available, additional data regarding efficacy and adverse events over the long term are needed.

• Behavioral approaches supporting glaucoma self-management have shown promising results indicating adherence is modifiable and varies over time. Long-term support is essential for continued adherence to recommended treatments, meaning that for the health care system to support ideal outcomes for glaucoma patients, new team-based approaches to glaucoma self-management support must be created and implemented.

Declaration of interest

P. A. N. Casey has received grants from the National Eye Institute R01EY031337, National Institute of Biomedical Imaging and Bioengineering R01EB032328, Centers for Disease Control and Prevention U01 DP006442 and, Research to Prevent Blindness Physician Scientist Award. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.