b'Glaucoma Interventions CriticalFor Preserving Sight, Quality of LifeDurham VAMC Research Improves Medication AdherenceGlaucoma is one of the leading causes of irreversible blindness. Avoiding that often requires lifelong adherence to treatment. An intervention led by the Durham, NC, VAMC helped patients not only improve compliance with their treatment regimen but also was a cost-saver. Now, the goal is to roll out the intervention to more VA facilities across the country.By Mary Anne DunkinDURHAM, NCOne of the leading causes of ir- anybody, but it is particularly not easy if you have reversible blindness, glaucoma affects an estimatedarthritis that makes it hard to grip the bottle, any 4%to6%ofthe Americanpopulationanduptotype of cervical spine issue that makes it difficult to 10%of African Americans.Becausetheconditionrecline the head to put the drops in, or if you have a is often associated with intraocular pressure (ocu- tremor that makes it hard to aim the bottle. And, of lar hypertension), treatment to prevent further nervecourse, she says, it can be challenging just remem-damageandblindnesstypicallyconsistsoftreat- bering to put them in. ments that reduce pressure within the eye, includingTheresultingintervention,whichconsideredall topical eye drops. of those factors, consisted of education about glau-While lifelong adherence to treatment is essentialcoma, aids to help assist with any physical barriers to to managing the condition and preventing blindness,compliance, a chart laying out when to use each drop research has shown that adherence to glaucoma treat- and for which eye, and a smart bottle that reminded ment regimens is often poor. Thus, efforts to under- veterans to take their drops.stand barriers to compliance and ways to improve orIn a clinical trial of the intervention, 200 patients circumvent it are crucial to preventing vision loss. were randomized to receive the intervention deliv-One such effort led by researchers at the Durhameredbyanophthalmictechniciandeliveredoran VAMC has been shown to improve both complianceactive control consisting of education about general with glaucoma treatment and reduce costs. Fundedeye care. The researchers then monitored the use of withaVAHSR&DCareerDevelopmentAward,eye drops in both the intervention and control armKelly W. Muir, MD, MHS, worked with a team ofwithanelectronicmonitortheyreceivedrelaying VA researchers to develop a multifaceted interven- how often they took their medicine and of how often tion to help improve the way patients self-managetheytookitonscheduleforsixmonths.The theirdisease.Theprocessinvolvedinterviewingintervention arm took their medications on schedule veterans concerning their problems with adhering toon average about 20 percent more frequently than treatment and watching veterans themselves or theirpatients in the randomized control arm, Muir said.1caregivers administer the drops.We really feel like there are many reasons whyImplications for Cost,folks may not be able to take their glaucoma medica- Treatment Intensification tions as prescribed, said Muir. These might includeKnowing that the intervention did improve adher-inadequateeducationabouttheimportanceoftheence,Muirsnextgoalwastodeterminewhether drugs or other medical conditions that make it dif- taking drops more regularly was associated with bet-ficult for patients to administer them. Actually get- ter outcomes and lower costs. Two subsequent stud-ting a drop in the eye is not an easy thing to do fories looked at those issues.39'