Treatment Plan

You Can Lead a Horse to Water...

BY LEO SEMES, OD, FAAO

The following quote, attributed to C. Everett Koop, MD, former U.S. Surgeon General, is indisputable: “Drugs don’t work in patients who don’t take them.” Much has been made of patient adherence to prescribed medications. But what about adherence to prescribed regimens? That is the next frontier. This applies to managing chronic diseases, such as glaucoma or cardiovascular disease, as well as to managing acute infections, for example.

Proper use of contact lens disinfection protocols comes under this umbrella as well. Commenting on a May 13, 2014 U.S. Food and Drug Administration Ophthalmic Devices Panel of the Medical Devices Advisory Committee workshop on this topic, well-respected educator Jeffrey Walline, OD, PhD, FAAO, stated, “As we improve products for our patients, we need to continually assess the guidelines to make sure that our patients are safe and the products are effective.”

Compliance Versus Adherence

At the recent Optometric Glaucoma Society meeting, which was juxtaposed to the annual American Academy of Optometry meeting in Denver in November, Steven Mansberger, MD, outlined the distinction between compliance and adherence to medications. While some have equated these two terms, adherence is the preferred terminology when describing how closely patients follow our prescribed regimens. You may also want to read Dr. Mansberger’s editorial on this subject (Mansberger, 2010). “Compliance” should be reserved for drill sergeants and the like.

His presentation reminded me of the significance of continued use of IOP-lowering regimens for my glaucoma patients. It also served as a reminder of the hazards of improper contact lens care. Patients should be directed not only to the proper administration of topical IOP-lowering drops and cardiovascular medications, but also to the proper use of contact lens disinfection regimens. We should take an interest in instructing our patients.

Taking Steps to Improve Adherence to Lens Regimens

Much has been written concerning adherence to glaucoma medications (Cook et al, 2014; Mansberger et al, 2013; Dreer et al, 2012). Patients have been documented as poor adherers. This also applies, surprisingly, to those being treated for cardiovascular disease. Oftentimes, poor adherence is recognized only when something goes awry, and it may be less apparent unless an acute event causes a patient to come in for a visit.

New York City Health has produced a program regarding the team efforts necessary for appropriate adherence (www.nyc.gov/html/doh/downloads/pdf/cardio/cardio-map-tools-manual.pdf). It is an interesting read that is worth accessing.

At the workshop mentioned previously, which was prompted in part by keratitis outbreaks in 2006 and 2007, revisions were considered regarding guidance documents for contact lenses and lens care products. Representative stakeholders from the ophthalmic professions and others testified (www.fda.gov); the focus was on preventing Acanthamoeba keratitis. By developing and applying guidelines for appropriate contact lens hygiene, it is likely that this can be contained.

Future directions for adherence programs such as those mentioned previously will go a long way to producing better outcomes for our patients, whether for preserving the vision of glaucoma patients or protecting patients from potential vision-threatening infections. CLS

For references, please visit www.clspectrum.com/references and click on document #231.

Dr. Semes is a professor of optometry at the UAB School of Optometry. He is a consultant or advisor to Alcon and Allergan, and he is a stock shareholder in HPO.