Compliance is the term used by the medical profession to describe the ability of a patient to follow a prescribed medication regimen in order to control a specific condition. Non-compliance is an important cause of visual loss in patients with glaucoma. The latest diagnostic techniques (which attempt to detect glaucoma prior to any visual loss) and treatment advances (which attempt to hold the disease at its current stage and prevent further optic nerve damage) are to no benefit in medical management if the patient is not compliant.

Compliance is particularly important in the treatment of glaucoma, since it is a chronic (ever-present) disease. But, we know that patient treatment plans for glaucoma are not usually simple to follow. Multiple medications often need to be taken several times daily at regular intervals for many years. In addition, medications have side effects ranging from minor and inconvenient to serious and disabling, requiring constant and effective communication between the patient and the doctor in order to design the best treatment plan for a given patient.

How can the glaucoma patient and the doctor work together to develop a treatment plan that encourages compliance? Here are The Foundation´s TOP 10 RECOMMENDATIONS for a successful and compliant treatment program:

1) Ask questions to understand how your treatment plan works and what the results may be. Patients who understand their disease and the treatment course are more likely to follow the treatment instructions and have more realistic expectations of the doctor and the management strategies.

2) Work with your doctor to simplify your treatment regimen to the extent possible. When possible, a patient should be using the least number of drugs, at the lowest concentrations, the fewest number of times per day. When treatment is being changed, medications should be prescribed for the same time of the day, if possible. Drugs should be introduced one at a time, to one eye only if the doctor feels it´s possible, and pressure changes in both eyes should be measured to evaluate efficacy and side effects.

3) Work with your doctor to fit the dosage regimen to your lifestyle to the extent possible. Discuss your daily routine (e.g., times of waking, morning break, lunch, return from work, evening meal, bedtime), and link the appropriate milestone to your installation schedule. For example, if pilocarpine precludes driving, it may be acceptable to your doctor if you instill the drops after getting to work and upon returning back home.

4) If you have difficulty remembering your medicine schedule, ask your doctor to help write out your treatment plan in large, clear letters - identifying the bottles by description as well as by name. If you have low-vision needs, use colored squares on the document to represent the bottle top color in order to reduce confusion.

5) Ask your doctor about the expected side effects of any new medication or surgery so that nothing takes you by surprise.

6) Remember that allergies to topical medications are often reactions to the preservatives (especially benzalkonium chloride). Should you have an allergic reaction, knowing this may encourage you to speak to your doctor about preservative-free options that may not produce the same results.

7) Rely upon trained staff in your doctor´s office, other than your doctor, to help you manage your disease more effectively and knowledgeably. Many doctors do not have the resources to regularly cover and repeat treatment factors will all of their glaucoma patients. Trained staff (like technicians or nurses) can take on many of these responsibilities and provide helpful assistance.

8) Keep pertinent information in writing: record the time each drug should be taken and the time of each eye examination; keep a journal of how your medication makes you feel so that you can relay this information to your doctor during your next visit.

9) Bring a relative or close friend with you to your doctor appointments. Patients often do not understand or cannot remember what they have been told, particularly if detailed information is provided immediately after a diagnosis has been made. Such a situation may create a shock-like state during which little, if anything, can be absorbed by the patient. Ask someone else you trust to document the doctor´s instructions in a way you can best understand, and have that person ask questions about anything that might be confusing.

10) Log on to The Glaucoma Foundation's Web site, where you can read and download helpful brochures, articles and past issues of the "Eye to Eye" Newsletter, and find links to other related organizations.


The most common forms of non-compliance are:

• Misunderstanding or not remembering the treatment plan that has been designed by the doctor.
• Failing to take the prescribed medication (this includes: missed doses, inadequate doses, premature ending of a medication without communication with the prescribing doctor, and taking the medication in a way that prevents it from being most effective).
• Increasing the number of doses and/or the amount of drug taken per dose, incorrectly assuming that ``if some is good, more must be better.´´
• Taking drugs not intended for the particular treatment (this includes drugs remaining from a prior treatment regimen and drugs from relatives or friends).
• Improper timing of drug administration, which is more likely to occur when the treatment plan is complex and involves numerous medications at frequent or unusual times during the day.
• Failing to fill the prescription for the intended and planned treatment.

                                                                                                               April, 2003