Successful glaucoma management depends heavily on patient adherence to their prescribed eye drop regimen. However, for many patients, compliance is a daily challenge. Complex dosing schedules, uncomfortable side effects, cost concerns, and other logistical barriers often stand in the way of consistent use. The result is suboptimal control of intraocular pressure, fluctuating pressures between visits, and an increased risk of disease progression.
As an ophthalmic scribe who works closely with our glaucoma specialist, I. Paul Singh, MD, I see the challenges our patients face every day. Over the years, I’ve learned how to identify when patients are not compliant with their glaucoma drops and the strategies we can take to overcome their struggles and help them stay on track. This article will explore the reasons that glaucoma patients struggle with compliance and outline strategies to help improve adherence and outcomes.
Complex Regimens and Dosing Schedules
Glaucoma regimens often involve multiple drops, each with a specific dosing frequency and spacing intervals to avoid washout effects. Maintaining a consistent routine can be difficult and overwhelming, and inconsistent dosing has consequences. Although pressure fluctuations may not always be evident during office visits, they can have a major impact on long-term progression. Therefore, educating patients on proper adherence is crucial.
A practical strategy to support patients and caregivers is to provide written drop schedules. We use charts that list the medication and cap color, frequency, and checkboxes for daily use. These tools make it easier to track adherence.
To better identify patients who may be struggling with compliance, I opt for open-ended questions like, “Can you walk me through your routine?” rather than simply asking, “Are you taking your drops?” This gives us a more honest picture and makes it easier to spot where problems arise.
Preservatives Impact Ocular Surface Health
A significant barrier to compliance is discomfort from preservatives. Patients often describe burning, stinging, or a foreign body sensation when instilling their drops. Over time, preservatives like benzalkonium chloride, or BAK, can cause chronic ocular surface disease (OSD), contributing to dryness, fluctuating vision, tearing, or morning crusting.
These symptoms not only are uncomfortable, but also they directly undermine adherence. Patients may skip doses, use drops every other day, or stop altogether when the experience is unpleasant.
As we do for patients when they report discomfort, when we see staining, tear film instability, or other clinical signs of OSD during their exam, we strongly consider a switch to preservative-free drops. These options not only protect ocular surface health but also improve comfort and adherence. The better patients feel, the more consistent they are with their therapy.
Glaucoma care is a lifelong endeavor, so anything we can do to improve adherence and streamline regimens helps prevent burnout and increase compliance while reducing the risk of future disease progression.
Simplifying Regimens With Combination Therapies
Although strategies like written drop schedules are effective, the best way to support compliance is to simplify the regimen whenever possible. Combination drops make compliance easier and reduce the stress patients often feel when faced with multiple bottles and time points every day. Switching patients from multiple bottles to a single combination therapy is not just about convenience—they feel empowered that glaucoma management no longer dominates their daily routine.
I’ve seen this transformation firsthand. Recently, a patient struggling with redness, irritation, and inconsistent use of multiple drops transitioned to a preservative-free combination therapy. The patient admitted he was skeptical at first but quickly became convinced by both the comfort and the simplicity. Within weeks, he looked and felt better. The redness faded, his lids no longer appeared puffy, and he reported consistency with his drops. Dr. Singh even showed him slit lamp images to demonstrate the improvement in his ocular surface.
Glaucoma care is a lifelong endeavor, so anything we can do to improve adherence and streamline regimens helps prevent burnout and increase compliance while reducing the risk of future disease progression.
Cost Concerns and the Value of Cash-Pay Models
Cost is one of the most common barriers we encounter, especially for older patients managing multiple prescriptions. The burden increases every time we add another drop to their regimen. Insurance coverage is inconsistent, prior authorizations create delays, and pharmacies frequently switch patients from branded to generics without clear communication.
Cash-pay models provide an important solution to these problems. For example, we prescribe Simple Drops (ImprimisRx), which are preservative-free combination drops mailed directly to the patient from a compounding pharmacy. In addition to reducing the number of medications and the financial burden, this solution is a cash-pay option that allows us to avoid prior authorization headaches. From a clinic perspective, each prior authorization we avoid saves hours of staff time and frustration. Instead of fielding multiple faxes, voicemails, and patient phone calls, we can focus more energy on patient care.
When explaining cash-pay options, transparency is important. I often encourage patients to add up what they’re already spending each month and compare it to the bundled price of a simplified regimen. Many quickly realize it’s not only affordable but also a way to dramatically cut down on hassle.
Being able to provide clear, accurate explanations without calling the doctor back builds trust and ensures patients leave the office with confidence about their care plan.
The Value of Staff Training
In our practice, staff training and education are key. We make sure our team understands the meaning of each cap color, the common pitfalls, and to encourage patients to bring their bottles to visits so we can double-check regimens. We also learn to identify issues related to physical limitations such as arthritis, tremors, or neck problems, which make it harder for patients to accurately administer several drops every day.
In addition, new employees complete structured training programs, and we offer ongoing group teaching sessions about topics like glaucoma medications and minimally invasive glaucoma surgery. Often, patients will ask me questions after the physician leaves the exam room. Being able to provide clear, accurate explanations without calling the doctor back builds trust and ensures patients leave the office with confidence about their care plan.
Conclusion
Helping patients stay compliant with glaucoma medications requires more than checking pressures and writing prescriptions. It means understanding that glaucoma drop management is a daily commitment accompanied by burdens of cost, discomfort, and more. Every patient requires a tailored approach, and we must use every available tool. This includes patient education and written schedules, along with combination therapies, preservative-free formulations, and cash-pay models. By prioritizing comfort, simplicity, and support, we can help patients overcome barriers to compliance, reduce the risk of progression, and preserve their vision.
