New data from a qualitative survey of glaucoma patients conducted by Santen in the UK, Spain, Italy and Germany shine new light on the reality of disease management for patients. The results illustrate how compounding factors including side effects from treatments and patient behaviors and experiences, can increase non-adherence to treatment, resulting in less controlled glaucoma and ultimately an increased risk of blindness.1, 2
“These findings reinforce that when patients encounter side effects, in addition to not experiencing an immediate benefit from administering their eye drops, they may not adhere to their treatment. Adherence can be further impacted if patients misinterpret stable IOP results as an indication that their dosing behavior will not impact glaucoma progression,” Dr. Andrew Tatham, Consultant Ophthalmic Surgeon at Princess Alexandra Eye Pavilion, Edinburgh, UK, said in a Santen news release. “By understanding the real-life experiences of our glaucoma patients, we can understand the real-life efficacy of their treatment and support more effective glaucoma management.”
The objective of the survey was to understand the daily realities and challenges for glaucoma patients. In order to strip out implicit biases and ensure a clear representation of the patient experience, the survey was designed in collaboration with a behavioral psychologist. The findings reveal that treatment side effects such as red, stinging eyes and blurry vision not only impact the vision experience and discourage adherence to treatment, but can also cause a loss of independence and may exacerbate depression.
“By using a non-traditional and discursive methodology, we were able to explore patient behaviors to try to understand issues with treatment adherence. Evidence showed that even for patients who had regular and consistent routines for administering their treatment, they would miss eye drop doses between consultations if the side effects interfered with their daily lives. This was also true for those who understood glaucoma blindness risks,” said Philip Graves, behavioral psychologist.
Many patients reported that they tried to compensate for missed doses by administering their drops immediately prior to a consultation. Since IOP measurements may be consistent at consecutive clinic appointments, their glaucoma may be assumed to have not progressed. However, this result is often a false reassurance of a ‘stable’ condition that is not reflective of day-to-day non-adherence. The patient may then incorrectly associate the report of stable IOP with stable glaucoma and the way they have used their eye drops, including missed doses. These behaviors can result in increased non-adherence to treatment, less controlled glaucoma and an increased risk of blindness. [1, 2]
“As a company dedicated to eye health, it is essential for us to understand the real-life experiences of patients living with glaucoma. Industry and ophthalmologists alike should consider adopting a more holistic approach, with the patient’s perspective at the heart. Santen is committed to learning from patients and listening closely to their needs in order to effectively support people living with glaucoma,” said Jean-Sebastien Garrigue, Head of R&D and Medical Affairs at Santen.
The survey was coordinated through one-to-one interviews with 32 glaucoma patients aged 55-80 years. Specialized questioning techniques were used to re-live experiences and find clues to the underlying unconscious processes that we know drive human behavior and decision-making. All patients were on medical glaucoma therapy (eye drops: fixed or non- fixed combinations).
Data on file. Expert working group on holistic glaucoma management virtual meeting. Meeting Report. NP-GLAU-EMEA-0210.
Newman-Casey PA et al. Ophthalmology 2020; 127(4): 477-483