Quality of life / Patient adherence
Personalized medicine in glaucoma – how can we do better?
Dr. Antony King said that we have to consider those that do not require treatment or monitoring; identify most effective treatment for individuals; improve monitoring strategies; improve cost-effectiveness and improve patient outcomes.
He emphasized that we already do personalized care when we analyzed data such as IOP, visual field and RNFL thickness. However, it’s what we base our personalized care decisions on that may be the problem.
He finished by suggesting that in future we hope to identify those who need ongoing surveillance because they have progressive disease and this will impact the cost of treatment of disease. Home monitoring could be the future for these patients. Artificial intelligence may have a role excluding disease.
How glaucoma affects patients
Dr. Carolina Gracitelli started saying that the glaucomatous disease leads to disabilities and impacts quality of life. Different longitudinal studies, should that visual field or RNFL thickness progression are associated whit lower quality of life. In some studies, inferior visual field was the most associated with worse quality of life scores.
She also presented that glaucoma impacts different activities such as driving, walking, reading, sleep and balance. Regarding driving, bilateral and possibly unilateral, glaucoma is associated with significantly higher rates of driving cessation amongst the elderly. Regarding reading, more than 40% of our patients complain about this issue. And in terms of interventions, increase contrast may be the best option for these patients. Balance is also compromised in glaucoma. The fear of falling is associated with depression and lack of independence.
She finished by saying that these tasks should be investigated, proper measurements are needed to address this issue and societies should be engaged in this topic.
Improving medication adherence
Dr. Paula Newman-Casey discussed the impact of glaucoma medication adherence, the magnitude of the problem of glaucoma medication adherence, why people don’t take their drops and steps towards improving medication adherence.
First, many clinical trials already proved that medication is able to preserve vision in glaucoma patients. However, not everyone uses medications. She presented 5 different patterns of glaucoma medication adherence over four years of follow-up. And she described reasons for difficulty with adherence: ability to instill eyedrops, knowledge, beliefs about glaucoma, beliefs about glaucoma medication, forgetfulness, cost, etc.
Finally, she explained that the Cochrane review of programs to improve medication adherence: evidence-based and theory-based interventions; tailored education; motivational interviewing-based counseling and reminder systems. She presented how to increase patient adherence: support, educate empower personalized glaucoma coaching program.
Patient reported outcomes measures
Dr. Ecosse Lamoureux explained that patient reported outcomes (PRO) are reports associated with health conditions that come directly from the patient. These are been used for research, clinical trials, healthcare and also for population health monitoring and quality performance management.
There are a variety of benefits of PROMs such as shared decision-making and improved communication; screening and monitoring of health conditions; facilitating early of problems and reducing unnecessary outpatient appointments. He presented a GlauCAT (item banking and computerized adaptive testing) to monitor these PRO. He presented some results of the implementation and some future steps such as automated messages that will be sent to patients 1 day prior to their glaucoma appointment.
Finally, he presented the significant impact of GlauCAT implementation project in terms of benefits to the patient and to the health system.
What is the key to improve adherence in NTG
Dr. Takeo Fukuchi presented the definition of “patient-centered medicine” (PCM) that means treatment is that the patients do for themselves. The center of the treatment is just on the patient. He presented two interesting different cases showing how patient adherence were crucial to stabilize the disease.
He explained the importance of adherence in glaucoma treatment that improve quality (accuracy) of treatment, increase the efficiency and effectiveness of treatment and improve patient prognosis. For NTG, the adherence is more important because the setting of the target IOP is uncertain in these cases, and the progression of visual field damage in relation to IOP during the course of the disease varies from case to case.
He presented some various barriers to adherence in NTG and what is the key to improve adherence in these patients (interview-type questionnaire, checking eye drop treatment and collect patient’s treatment status and feedback and opinions).
He finished explaining that a comprehensive eye care team aiming to improve the prognosis of glaucomatous patients.