C. Everett Koop, the former U.S Surgeon General, has rightly remarked,
“Drugs don’t work in patients who don’t take them.”
Simply prescribing anti glaucoma drops and telling the patient, "See you in three months . . . next patient, please!" is not the right approach when we are dealing with “glaucoma”.
Remember:
Communication, Communication, Communication: Optimal treatment of patients with a chronic condition such as glaucoma requires a detailed conversation between the patient and the ophthalmologist that continues over the years. These conversations must regularly reinforce the benefits of ocular hypotensive therapy and regular follow-up visits.
In patients with multiple medical conditions who tend to be less compliant, polypharmacy, can lead to deletion of medication that patients think are less important. For example, if given a choice between affording or remembering to take a heart medication or an eye drop, the patient may logically choose the heart medication. Therefore a proper patient counseling about the disease process, the rationale for treatment and how drugs act, and the need of life long medication and follow up cannot be over emphasized.
Regular assessment of the medication regimen: Consider the simplest feasible medication regimen that will meet the patient’s needs. Be alert to side effects that might reduce compliance and persistency and consider changing the regimen if problems arise.
Ensure patient understanding of correct drop instillation technique: When starting a patient on drops for the first time, consider a ‘‘practice bottle’’ of artificial tears. At each visit, have a staff observe the patient instilling drops in the office. Instruct patients regarding the timing/spacing of drops and, depending on the regimen, consider a device to administer the drop.
Be attuned to cost issues: Patients may be embarrassed to admit they cannot afford the medication or follow-up visit fee, and ophthalmologists need to be sensitive to the possibility that cost is an issue. Patient assistance programs from pharmaceutical companies can be offered to patients having difficulty paying for medications.
Help patients remember eyedrops into their routines: Cues such as teeth brushing, morning coffee, or administration of other medications may help patients remember to instill the eyedrops. Ask patients to keep a calendar and check off when drops are instilled.
Advise patients who work, especially those who work shifts, to consider keeping an extra bottle at the work site.
Example of a drug dose reminder chart:
| Drug | Morning | Noon/Evening | Night/Bedtime |
| Betablocker (Timolast™) | Ö | Ö | |
| Dorzolamide (Cosopt™) | Ö | Ö | Ö |
| Travoprost (Travatan Z™) | Ö |
Practical tips:
The most common techniques for detecting non-compliance are:
· Patient interview: Use open ended questions rather than statements,
· Clinical outcome
· Calculation of number of bottles used per month.
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