الفهرس 
Non adherence is a real problemOnly 14 pages are availabe for public view
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Abstract
Glaucoma is the second leading cause of blindness in the world according to the World Health Organization. While there are multiple treatments for glaucoma, medical therapy is still the mainstay of therapy, especially in the early phases of the disease. Lack of persistency with dosing can lead to persistent elevation or fluctuations of intraocular pressure (IOP), which has been shown to be a risk factor for glaucomatous progression. Therefore, improving patients’ adherence to therapy is of the utmost importance.
Adherence is the preferred terminology as compliance suggests a passive role following the doctor’s orders. Adherence is not the same as ‘concordance’ which includes an agreement about treatment between the patient and prescriber. Adherence to a medication regimen is generally defined as the extent to which patients take drugs as prescribed by their healthcare providers.
The methods available for measuring adherence could be broken down into direct and indirect methods of measurement. Each method has advantages and disadvantages, and no method is considered the gold standard. Direct approaches are expensive, burdensome to the health care provider, and susceptible to distortion by the patient. Indirect methods of measurement of adherence include asking the patient, assessing clinical response, ascertaining rates of refilling prescriptions, collecting patient questionnaires, using electronic medication monitors, measuring physiologic markers on multiple occasions have been used. Although certain methods of measuring adherence may be preferred in specific clinical or research settings, a combination of measures maximizes accuracy.
There are many reasons for patients to be non-adherent to their treatment regimens. Some of these include cost of medications, inability to dose the medications themselves, side effects, and failure to understand the role of medical therapy in the treatment of their disease. However, the most commonly cited reason is patient forgetfulness. Un¬fortunately, in a disease such as Primary Open Angle Glaucoma, the motivation to take DROPs may be low because the patient typically has no pain or other symptoms that would prompt adherence to a medication regimen. It’s important to educate the patient about the need for the medication and how to use it, and equally im¬portant to take the time to make sure the patient understands the handling and administration of the DROPs as well as what results to expect. Using visual aids, fact sheets and other educational material can improve compliance.
Mini¬mizing dose frequency and the use of less number of eye DROPs can be particularly helpful to pa¬tients who are taking many med¬i¬cations every day. Glaucoma patients should be aware of the proper eye DROPs instillation technique
In the present study, the questionnaire was the chosen method of evaluating the adherence level in a randomly chosen 110 Egyptian POAG patients, and the following had been dedicated:
In this sample, the adherence level was 61.8%. Forgetfulness was the main adherence obstacle and we have to do something about it. Being diseased with more than one chronic illness will passively affect the adherence level either by making regimens more complex as regards both doses & cost, or by being pessimistic. Less frequently used topical eye DROPs with fewer side effects should be used.
Most patients reported no instillation difficulties; they also reported that this was the first time they had been asked about the maneuver of their eye DROPs instillation. Thus it is recommended to make sure that every patient instills his eye DROP properly. Every healthcare giver member and even expert patients could be helpful.
The only two findings that had been proved to have a statistically significant effect on the Egyptian POAG patients’ adherence level were: (1) Being free from other chronic illness affects the adherence level positively. (2) When the patients’ concept about their disease prognosis is good or even steady, the adherence level is positively increased.
The topic of adherence to chronic diseases treatment regimens needs more spotlights to be focused on.