Interventions for improving adherence to ocular hypotensive therapy

  • Review
  • Intervention




Poor adherence to therapy is a significant healthcare issue, particularly in patients with chronic disease such as open angle glaucoma. Treatment failure may necessitate unwarranted changes of medications, increased healthcare expenditure and risk to the patient if surgical intervention is required. Simplifying eye drop regimes, providing adequate information and ongoing support according to patient need, may have a positive effect on improving adherence.


To summarise the effects of interventions for improving adherence to ocular hypotensive therapy in people with ocular hypertension (OHT) or glaucoma.

Search methods

We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, ZETOC and OpenSIGLE. In addition, we searched research registers of ongoing studies. We contacted pharmaceutical manufacturers to request unpublished data and searched conference proceedings for the Association for Research in Vision and Ophthalmology (ARVO), and the Annual Congress for the Royal College of Ophthalmologists (RCO). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 15 January 2009.

Selection criteria

We included randomised controlled trials (RCTs) and quasi RCTs that compared interventions to improve adherence to ocular hypotensive therapy for patients with OHT or glaucoma.

Data collection and analysis

At least two authors independently assessed the search results for eligibility and extracted data for included trials onto specifically designed forms. We calculated the mean difference for continuous data and relative risks for dichotomous data. Where appropriate, we pooled data using a fixed-effect model.

Main results

Eight trials met the inclusion criteria. There was considerable heterogeneity of interventions and reported outcome measures and therefore, meta-analysis was limited to two studies. Overall, studies were not of high quality due to small sample sizes, missing data and short term follow-up. Three of five drug comparison studies provided evidence that reducing the frequency of drops can improve adherence. However, the study that compared the least frequent regime with one of the most complicated, showed no difference in reported adherence. A small study of thirteen patients found a reminder device beneficial to adherence levels yet only one of two studies involving education and individualised care planning was found to be successful.

Authors' conclusions

Interventions involving simplified dosing regimes, reminder devices, education and individualised care planning, did show improvements in adherence rates. However, due to inadequate methodological quality and heterogeneity of study design we are unable to advocate any particular interventions at this time.






總結促進高眼壓(ocular hypertension (OHT))或青光眼患者順從降眼壓治療之介入措施的影響。


我們搜尋了CENTRAL,MEDLINE,EMBASE,CINAHL,PsycINFO,Web of Science,ZETOC及OpenSIGLE。此外,我們還搜尋了正在進行中的研究清單。我們聯絡藥廠以尋求未發表的資料,並搜尋the Association for Research in Vision and Ophthalmology (ARVO,與the Annual Congress for the Royal College of Ophthalmologists (RCO)的會議記錄。檢索條件不限制語言或日期。最近一次搜尋電子資料庫是在2009年1月15日。


我們納入比較促進高眼壓或青光眼患者順從降眼壓治療之介入措施的隨機對照試驗(randomised controlled trials (RCTs))與類隨機對照試驗。









此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

Interventions for helping people use eye drops as prescribed for raised eye pressure or glaucoma

A large number of people do not use eye drops as prescribed. Glaucoma is a slowly progressive eye disease, which can result in severe vision loss. Drops prescribed for raised eye pressure or glaucoma are aimed at lowering the pressure to assist in reducing the rate of progression, or preventing the conversion of raised eye pressure to glaucoma. It is important that these eye drops are used continually, usually for life. Approximately 70% of people who are prescribed eye drops for the first time, fail to continue collecting prescriptions within the first year and even when patients collect prescriptions they do not always use the drops as frequently as they should. A number of reasons are thought to be the cause, for example, forgetfulness, being prescribed a large number of medications, difficulties instilling drops, a busy lifestyle and seeing no benefit.

This review is based on eight studies that tried out different methods to help people to use drops as prescribed. The following interventions were included; simplifying drop routines, reminder devices, providing information about glaucoma and offering advice regarding day to day issues with eye care. Five of the eight studies showed that these interventions helped people take their eye drops reliably. Unfortunately, not all of these studies were of high quality and, therefore, until more evidence is available we cannot recommend any particular method. Good quality research is needed in this area in order to develop a better understanding of patients' individual needs and to help us provide more effective eye care services.