Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Factors Affecting Compliance with Eye Drop Therapy for Glaucoma in a Multicultural Outpatient Setting

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Factors Affecting Compliance with Eye Drop Therapy for Glaucoma in a Multicultural Outpatient Setting

Article excerpt


Glaucoma is the name given to a group of eye diseases that involve the gradual destruction of the optic nerve. Chronic, primary open-angle glaucoma is the most common form of this disease. Damage occurs due to an increased pressure inside the eye resulting from a blockage in the circulation of aqueous or its drainage from the eye. Glaucoma is one of the leading causes of irreversible blindness in Australians over the age of 50, affecting two per cent in this age group.

The increased ageing of our population and the increased prevalence of all types of glaucoma as people age, mean that more health care staff will be involved in the care of patients receiving anti-glaucoma drugs in the future (Goldberg 1997).

Uncontrolled glaucoma can cause irreversible damage to the optic nerve fibres. The peripheral vision is damaged first, forming a tunnel pattern visual field loss. Chronic open angle glaucoma is asymptomatic and visual loss may be well advanced before the patient seeks help. Spaeth in 1970 (before regular screening was introduced) estimated that 80% of vision was lost before patients at his clinic realised there was a problem and sought help. Glaucoma is often therefore known as the 'sneak thief' of sight.

Regular screening by optometrists and ophthalmologists can identify so-called glaucoma suspects and appropriate treatment can be commenced before damage occurs. Checks are recommended every second year for people over the age of 40 and every year for those with diabetes or other eye pathology. Lowering the intraocular pressure is the most effective means of preventing damage to the optic nerve fibres.

Eye drops are the most common form of treatment and must be used regularly on an indefinite basis. Common undesirable side effects of these drops include burning and stinging on instillation; Pilocarpine can cause decreased night vision and nightmares and Latanoprost can change iris colour. Multiple drops may be needed to provide good control of intraocular pressure and they can be expensive.

Compliance is generally understood as the extent to which patients' actions and behaviours match the physician's instructions. Lack of patient compliance with glaucoma therapy was identified many years ago as a significant problem in effective treatment (Riffenburgh 1966; Spaeth 1970) and continues to be a major problem today. Many modern studies are based on data collected by these early researchers (e.g. Tsai et al. 2003; Schwartz 2005).

Several studies have confirmed the link between non-compliance and progression of vision loss (Bloch et al. 1977; Zimmerman and Zalta 1983; Stewart et al. 1993). Vision loss can impact on employment, independence and emotional wellbeing and is associated with an increased risk of falls, depression and need for health services in the older patient (Eye Research Australia 2005). Understanding the factors that are involved in compliance is therefore of the utmost importance to our patients and of particular interest to nurses who have an important role in patient education and advocacy.

Reasons for non-compliance

Reasons given for non-compliance are many and diverse. Tsai and his colleagues (2003) performed in-depth interviews with 48 patients with glaucoma.They grouped reasons for noncompliance into four categories:

? Situational/environmental (49%); for example, going on holiday and forgetting to bring drops;

? Medication regimen (32%); for example, inconvenient timing;

? Patient factors (16%); for example, forgetfulness;

? Provider factors (3%); for example, dissatisfaction with the ophthalmologist.

Patel and Spaeth (1995) reported a similar range of factors significantly influencing compliance: daily dose frequency, forgetfulness, inconvenience, and unaffordability (sic). Gender and race were marginally significant factors, with women and Caucasians reporting somewhat lower rates of missed doses.

Many researchers (starting perhaps with Riffenburgh 1966) point out that since chronic glaucoma usually produces little pain or immediate disability, there is little reinforcement to continue treatment. …

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