Worse follow-up adherence linked to glaucoma severity

This prospective study found that patients with severe glaucoma and those being treated with glaucoma medications showed worse compliance with follow-up appointments compared to patients with mild or moderate disease. The results suggest that poor follow-up may contribute to disease worsening or, alternatively, that those with more severe disease are less inclined to follow up at appropriate intervals.

This is the first study to show that more severe disease is associated with poor adherence to follow-up recommendations. A cross-sectional study, it included 206 patients with established glaucoma seen at a San Francisco county hospital serving indigent and underinsured residents. No prior study has examined the relationship between disease severity and follow-up adherence in an underserved population.

Compliance with recommended follow-up exam intervals was determined by reviewing medical records for the year preceding commencement of the study. Glaucoma severity was determined based on the Academy’s Preferred Practice Patterns guidelines.

After adjustment for potential confounding variables, subjects with severe glaucomatous disease were found to have been less adherent to their recommended follow-up than those patients with mild or moderate glaucomatous disease (P = 0.01). Those taking glaucoma medications were found to be less adherent to follow-up recommendations (P = 0.01). Age, sex, race, education level, years since diagnosis and glaucoma surgery were not found to be statistically significant variables for follow-up adherence.

This research could have implications for targeting “at risk” patients and perhaps intervening with additional education or behavior-modifying activities. The authors say that interventions aimed at improving follow-up have the potential to slow progression. They hypothesize that patients taking IOP-lowering medications may have the false perception that their use obviates the need for regular physician follow-up. They encourage providers to educate patients regarding the importance of follow-up adherence.