Topical Medication Adherence and Visual Field Progression in Open-angle Glaucoma: Analysis of a Large US Health Care System.

PRCIS: Modeling of visual field and pharmacy data (Kaiser Permanente, 2001 to 2014) from open-angle/pseudoexfoliation glaucoma patients in clinical practice indicated a significant inverse association between the level of medication adherence and rate of visual field progression. PURPOSE: The aim was to quantify the effect of nonadherence to topical hypotensive medication on glaucomatous visual field progression in clinical practice. METHODS: Retrospective analysis of combined visual field and pharmacy data from Kaiser Permanente Southern California's HealthConnect electronic health record database. Patients with a diagnosis of primary open-angle glaucoma or pseudoexfoliation glaucoma (2001 to 2011) and ≥3 subsequent visual field tests of the same Swedish Interactive Threshold Algorithm type were followed up from first medication fill to final visual field test. Medication adherence (proportion of days covered) was estimated from pharmacy refill data. A conditional growth model was used to estimate the effect of adherence level in modifying the progression of mean deviation over time after adjusting for potential confounders, including age, sex, race/ethnicity, baseline glaucoma severity, and comorbidity. RESULTS: In total, 6343 eligible patients were included in the study and followed for (mean) 5.8 years; average treatment adherence during follow-up was 73%. After controlling for confounders and the interaction between time and baseline disease severity, the model indicated that mean deviation progression was significantly (P=0.006) reduced by 0.006 dB per year for each 10% (absolute) increase in adherence. Model estimates of time to glaucoma progression (mean deviation change -3 dB from baseline) were 8.3 and 9.3 years for patients with adherence levels of 20% and 80%, respectively. CONCLUSIONS: Improving patient adherence to topical glaucoma medication may result in slower deterioration in visual function over time.

Characterization of Glaucoma Medication Adherence in Kaiser Permanente Southern California.

PURPOSE: To describe adherence to glaucoma medications. PATIENTS AND METHODS: Medication adherence was investigated using the computerized records of Kaiser Permanente Southern California, a group model health maintenance organization that provides care to 3.4 million residents of Southern California. Eligible glaucoma patients were diagnosed between 2005 and 2009 and had medical and prescription drug coverage between 2005 and 2009. Utilization and adherence parameters were calculated for each of the 5 years from the incident date. RESULTS: A total of 17,943 newly diagnosed glaucoma patients were identified between the years 2005 and 2009. Of patients diagnosed with glaucoma in 2005, 71% were continuously eligible for 5 years. Medication adherence was calculated using a medication possession ratio. Adherence was bimodal and not normal in distribution. Overall, the mean age of the entire group was 66 years, with 56% being 65 years of age or older. The high adherence group tended to be older, more likely to be female, and more likely to be white. The low adherent group (younger) tended to have more and worse diabetes, renal disease, myocardial infarction, and stroke. CONCLUSIONS: The shape of the adherence distribution appears bimodal, so analysis based on parametric measures may not be appropriate. Investigations of adherence should probably be performed separately for the low, mid, and high groups.

The prevalence of glaucomatous risk factors in patients from a managed care setting: a pilot evaluation.

OBJECTIVE: To report percentage of patients who present with glaucomatous risk factors (RFs) and determine average cumulative 5-year glaucoma progression risk in a subset of ocular hypertensive patients using the Ocular Hypertension Study (OHTS) predictive risk scoring system. STUDY DESIGN: A retrospective chart review of patients treated at a large ophthalmology clinic for International Classification of Diseases, Ninth Revision glaucoma-related diagnoses. METHODS: Medical records were screened for demographic, clinical, and ocular RFs. Data were collected on ocular attributes, and descriptive, cross-tabulation, and regression statistics were applied to depict prevalence and potential influence of RFs. For the ocular hypertension subset, the OHTS risk scoring system calculated average cumulative 5-year risk of glaucoma conversion. RESULTS: With 1189 eligible medical records available, univariate analyses demonstrated significant associations between older age and mean deviation (MD), vertical cup-to-disc ratio (CDR), intraocular pressure, and central corneal thickness (CCT). The presence of diabetes mellitus had a protective effect. Regression analyses identified age, mean CCT, and CDR as significant predictors of MD, whereas CCT was the strongest predictor of vertical CDR. Mean composite OHTS score was 9.7, signifying a 15% cumulative 5-year risk for developing glaucoma. CONCLUSIONS: Known RFs were present in approximately one third of patients. Although analyses confirmed the predictive value of these RFs, existing models may not account for several important RFs or may rely on ocular metrics that might not be routinely or practically assessed in clinical practice. Additional studies are required to incorporate these considerations into future predictive models to enhance their clinical application and the interpretation of risk estimates.