Glaucoma and cataract patients face a variety of challenges with eyedrop compliance. Common issues when using drops include forgetfulness, confusion related to administering multiple medications daily, medications being expensive, and challenges in physically administering drops — such as mobility issues in joints. Ophthalmic technicians can play important roles in helping patients improve adherence to their drop regimens and thus prevent vision loss.

Know the obstacles

Glaucoma patients are among the worst sector when it comes to compliance with using IOP-lowering drops. I suspect that fewer than 25% of my glaucoma patients use drops on time and every time religiously.

It may be because glaucoma patients don’t immediately notice vision loss that they are often less compliant. Another reason is that these patients don’t experience any immediate relief when using drops, as they would from artificial tears, and patients might slack off by knowing that they will have to use drops forever.

Side effects can be another deterrent. Glaucoma drops can redden and irritate eyes, and they can cause hyperemia, increase the incidence of blepharitis, and worsen dry eye disease. When glaucoma patients fail to properly use their drops, optic neuropathy can worsen because IOP isn’t kept in check, which can lead to functional vision loss in the visual field.

Cataract patients do a much better job of taking their drops, most likely because they only have to use them for a few weeks. The advent of compounding pharmacies that provide combination eyedrops has been a game changer for compliance by this sector. Medications that required three different bottles post cataract surgery can now be combined into one.

When cataract patients fail to properly administer eyedrops, corneal edema can worsen or inflammation can occur, resulting in a lengthier visual recovery. Noncompliant patients are also more prone to infections.

Top roles

Ophthalmic technicians’ chief role is to make sure patients order drugs from the correct pharmacy and that the prescribed dosage will result in the best coverage from their insurance company. For example, even if a patient is supposed to use a drug three times a day, it may be prudent to prescribe it twice daily. Otherwise, patients may be overcharged or get more bottles than needed.

Technicians can also handle recalls, refills, and prior authorizations. Before ordering a drug, technicians can use built-in software in electronic medical record systems to identify which drugs a patient’s insurance covers and which have the lowest out-of-pocket expense. Software can also flag if a prior is authorization needed. Technicians can ask pharmacy representatives for coupons and discount cards and for advice on how to use them to get the best pricing.

If a drug isn’t commonly used or if a pharmacy is in a rural location, technicians should make sure a pharmacy has it in stock and if not, find out how long it will take for them to get it. Otherwise, if patients go to a pharmacy and must leave empty handed, they will likely be irate — and may not bother to promptly make another trip to obtain the drug.

Technicians can also instruct patients on how to instill drops, how often to use them and for how long, and possible side effects. Caregivers are encouraged to hear this information also, so they can assist patients if needed.

Detective work required

It’s also helpful for technicians to play detective — that is, look for clues that patients aren’t taking their drops properly. One way to do this is to ask patients to name their drugs and tell you the color of the bottle caps, which reveal a topical ocular medication’s class (tinyurl.com/OPCompliance123 ). If they can’t recall that information, there’s a good chance they’re not being fully compliant.

The key is to ask open-ended questions. If a technician simply asks a patient if they’re taking their drops correctly, they will most likely say “yes.” And never ask patients if they’re taking a specific drug by name. Instead, request that they tell you what they’re taking. If they say, “it’s in my chart,” tell them that you want to review this with them to make sure you have it documented correctly.

Check your attitude

It’s also important to not appear judgmental when questioning patients. If a technician leads with, “I know it’s hard to use drops. How often do you think you get them in properly, would you say 50% or 75% of the time?” I find that nine times out of 10, they will admit to only half the time. Then deduct 25% from that amount to get their true percentage.

By leading with a high number, patients will typically report something much less than that. If they are an extreme case, they will feel less judged and more likely to reveal the truth.

Pharmacology basics

Technicians will find that having a basic knowledge of pharmacology can be helpful. By knowing five or six of the most commonly used glaucoma drops, technicians can save time in the clinic. If a patient reports an allergy to a drop and doesn’t want to use it again, for example, a technician can find out the class by asking the color of the bottle’s cap.

Or, if a new patient is already using glaucoma drops and doesn’t know which one, asking what color the cap is can solve the puzzle.

Other tips and tricks

Nowadays, many digital devices are available that patients can use to set alerts, such as smartphones, smartwatches and computers. Technicians can recommend savvy patients use them to set reminders to take their medications.

There are also some low-tech, commonsense ways to establish reminders, such as taping a dosing schedule to the refrigerator or bathroom mirror.

If a patient uses drops four times a day, techs should recommend that they correlate using them with tasks they perform daily, such as when eating breakfast, lunch, and dinner, and going to bed. For patients who fall asleep and forget to take their last glaucoma drop for the day, suggest they take it right after dinner.

For effective adherence to glaucoma medication use that stops vision loss, it is critical that technicians understand all the important ways that they can help patients be better compliant with drop administration. OP

Dr. Williamson is a partner and refractive and anterior segment surgeon at Williamson Eye in Baton Rouge, La. He reports no relevant financial disclosures.