Glaucoma: Looking Ahead to Improved Compliance and Visual Outcomes
Including proceedings from a symposium during the American Academy of Ophthalmology's Annual Meeting in Las Vegas, Nevada
Activity Date: April 2007  — Activity Info: Volume 4, (3)

Glaucoma: Looking Ahead to Improved Compliance and Visual Outcomes
Henry D. Jampel, MD, MHS*

Glaucoma has become the second leading cause of preventable vision loss worldwide. In the United States, glaucoma prevalence is increasing because of the aging population, and by 2020, nearly 80 million people worldwide will be diagnosed with the disease.1

Because glaucoma is asymptomatic through the early disease stages, one of the key challenges in glaucoma management is to identify patients at risk. Early detection of glaucoma is important to not only ensure optimal visual outcomes but also control healthcare costs. In our review of medical records from 151 patients with glaucoma (ie, primary open-angle glaucoma, normal-tension glaucoma, or glaucoma suspect), we found that medication costs comprised 24% to 61% of the total direct costs for glaucoma, and the direct costs of glaucoma management increased with worsening disease severity (Figure 1).2 Importantly, we also found that the proportion of costs from medication varied when realistic assumptions of medication adherence were considered (Figure 2); the costs shift toward surgery and low-vision services, indicating that the patient has reached a disease stage with very limited options.2 Therefore, early and effective use of glaucoma medications could not only potentially significantly reduce the economic burden of glaucoma but also delay the burden of disease for several years. Indeed, patients in all stages of the disease deserve appropriate treatment.

Adherence can be defined as the extent to which the patient's behaviors correspond with the provider's recommendations. Glaucoma presents several challenges to optimal adherence, including measuring adherence (eg, measuring eye drops instead of pills) and improving adherence in a disease area that is affected by several non-etiologic factors.

This issue of Johns Hopkins Advanced Studies in Ophthalmology includes proceedings from a symposium held during the American Academy of Ophthalmology's Annual Meeting on November 13, 2006, in Las Vegas, Nev. Gail F. Schwartz, MD, an ophthalmologist in private practice, opens with a review of our current knowledge of adherence in glaucoma and highlights ophthalmologists' ability to evaluate patients at risk for poor adherence. She also provides practical strategies to improve adherence based on her own experience. James C. Tsai, MD, from Yale University School of Medicine, then considers some of the challenges in measuring adherence, including the role of diurnal fluctuation of intraocular pressure. He also continues the offering of practical strategies for improved adherence based on his own clinical and research experience and outlines his recommended approaches. Next, Paul P. Lee, MD, JD, from Duke University Eye Center, describes a joint effort between industry and organized medicine, through the Patient Care Improvement Project, which seeks to identify the most effective ways to improve patient adherence in glaucoma by soliciting ideas from ophthalmologists, ophthalmology technicians, and patients with glaucoma. We also include a summary of the lively question and answer session from the symposium.

Finally, for this monograph, I had the opportunity to interview Harry A. Quigley, MD, a thought leader in the field of glaucoma adherence and epidemiology. Dr Quigley provides us with a first-hand view of the practicalities in addressing glaucoma adherence.


1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262-267.
2. Lee PP, Walt JG, Doyle JJ, et al. A multicenter, retrospective pilot study of resource use and costs associated with severity of disease in glaucoma. Arch Opthalmol. 2006;124:12-19.

Figure 1

Figure 2

The content in this monograph was developed with the assistance of a staff medical writer. Each author had final approval of his/her article and all its contents.

*Odd Fellows and Rebekahs, Professor of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Address correspondence to: Henry D. Jampel, MD, MHS, Odd Fellows and Rebekahs, Professor of Ophthalmology, Johns Hopkins University School of Medicine, Maumenee B-117, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287-9205. E-mail:

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