Glaucoma is a chronic disease that requires long-term cooperation between the patient and the ophthalmologist. The prescribed treatment is usually long-term and requires frequent monitoring, therefore patient compliance is very important to therapeutic success. It is crucial that the patient has a good understanding of their disease, what stage it is, what it is about to be treated, and what benefits to and cannot expect from treatment.

It is believed that around 10% of glaucoma damage and associated blindness is caused by patients not taking their medications regularly and not going for check-ups. Glaucoma patients are often elderly people who have memory or physical problems that make it difficult to instill the drug. In addition to the inability to apply the drug, problems may be caused by administering an excessive amount of the drug to the conjunctival sac (which may increase systemic side effects), as well as arbitrary use of drops not prescribed by the doctor, incorrect timing of drops and irregular use.

White coat team

The literature describes " white coat syndrome ", in which in the perspective of the upcoming visit the patient's urgency to comply with medical recommendations suddenly grows. About a week before the visit to the doctor, the patient begins to take medications regularly, but this ends within a few days after the visit. Some of the failures in the treatment of glaucoma can be explained in this way.

Despite the existence of treatment regimens that are very convenient for patients, with only one drug application per day, as well as much better access to knowledge about the disease and despite numerous information and preventive actions, no improvement has been registered for over 25 years patient-doctor cooperation indicator.

The data is appalling. According to the European Glaucoma Society (EGS), the proportion of patients who cooperate well with a doctor in the treatment of glaucoma is consistently in the range of 30-70%. and is surprising not only for doctors but also for patients. Studies have shown that patients often overestimate their cooperation with the doctor and rate it as good, when in factthey only partially follow the recommendations of the attending physician.

How to recognize glaucoma?

Why do patients fail to comply with medical recommendations?

The European Glaucoma Society considers four main groups of causes to be predominant:

1. Factors related to the life situation (important events in the patient's life, lifestyle associated with frequent travels) 2. Treatment-related factors (drug costs, unpleasant side effects) 3. Factors related to the patient's person (poor understanding of the disease, presence of comorbidities) 4. Support factors (poor communication with the treating physician) In addition, additional factors also influence, such as:

  • gender (men work worse)
  • the stage of the disease (patients with less glaucomatous lesions usually do not comply with the doctor's recommendations)
  • difficulties with instillation of the drug and lack of help from other people

How can the patient-doctor cooperation be improved?

1. The patient must make sure that the doctor explains glaucoma and its treatment very carefully and clearly. Sometimes it is necessary for the physician to contact the patient's family and mobilize their members to care for the patient. 2. The patient must understand that the goal of therapy is not to improve vision, but to stop the progression of optic atrophy. Often times, when the patient does not see improvement in their vision, they will stop treatment. 3. The patient should be aware of possible side effects of drugs and should always be able to contact the treating physician if they occur. A proper and empathetic relationship on the part of the physician with the patient is the basis for improving patient cooperation 4. The amount of drugs used and the frequency of their administration should be kept to the minimum necessary. Complicated drug regimens significantly reduce patient compliance. 5. The patient must learn the correct technique of administering the drug (proper instillation, closing the eyelids, pressure on the tear points, the time interval between the administration of different drops), which significantly reduces the incidence of side effects and unpleasant symptoms associated with them.

The cooperation of the patient with the doctor and the patient's proper compliance with medical recommendations have a huge impact on the effectiveness of glaucoma treatment and can prevent its progression. Even the best medications don't work if they're not taken.

Glaucoma - treatments for glaucoma

About the authorBarbara Polaczek-Krupa, MD, PhD, specialist in eye diseases, Centrum Opulystowa Targowa 2, Warsaw

Dr. med. Barbara Polaczek-Krupa,initiator and founder of the T2 Center. She specializes in modern diagnostics and treatment of glaucoma - this was also the subject of her PhD thesis defended with honors in 2010.

Dr. med. Polaczek-Krupa has been gaining experience for 22 years, since she started working at the Ophthalmology Clinic of CMKP in Warsaw, with which she was associated in 1994-2014. During this period, she obtained two degrees of specialization in ophthalmology and the title of doctor of medical sciences.

In the years 2002-2016 she worked at the Institute of Glaucoma and Eye Diseases in Warsaw, where she gained knowledge and medical experience by consulting patients from all over Poland and abroad.

For years, as part of cooperation with the Medical Center of Postgraduate Education, he has been a lecturer at courses and trainings for doctors specializing in ophthalmology and primary he alth care.

He is the author or co-author of numerous publications in scientific journals. Member of the Polish Ophthalmology Society (PTO) and the European Glaucoma Society (EGS).

Category:

Eye diseases and vision disorders