The Effect of Intensive Education on Concordance with the Age-Related Eye Disease Study (AREDS) Recommendations in a Tertiary Referral Practice

Abstract

Background/Aims: The Age-Related Eye Disease Study (AREDS) showed that supplementation with their formula led to a significant decrease in progression of age-related macular degeneration (AMD). This study aims to assess the effect of different education protocols on concordance with the trial recommendations in two retinal clinics. Methods: A prospective controlled survey of concordance with the AREDS recommendations in two retinal clinics was administered to 330 patients with AREDS category 3 or 4 AMD. The results were evaluated to assess the effect of differing levels of patient education. In clinic 1, there was a formal policy of giving the patient both verbal and written instructions and verbal repetition of these instructions from each staff member on each patient visit; in clinic 2, there was no specific education policy. Results: Clinic 1 had a concordance rate of 81.6% and clinic 2 of 44.1%. There were no significant differences in the patient demographics between the two clinics. Conclusion: A high concordance rate can be achieved in clinical practice with rigorous patient education that includes a policy of having continual repetition of instructions.

What Advice Is Currently Given to Patients with Age-Related Macular Degeneration (AMD) by Eyecare Practitioners, and How Effective Is It at Bringing about a Change in Lifestyle? A Systematic Review

“…Weaver and Beaumont (2015) aimed to understand lifestyle changes that patients make as a result of the way advice is given [ 59 ]. They found after interviewing patients attending two different clinics (clinic 1 with a strict protocol driven regime about giving lifestyle advice and clinic 2 that had no policy), that 81.6% of patients attending clinic 1 made lifestyle changes consistent with the advice they were given compared to 44% of patients in clinic 2.…”

“…It also was not always apparent whether lifestyle changes of those surveyed were made directly as a result of ECP advice, but there was evidence from several studies to suggest that advice received from ECPs was impactful, particularly advice about nutritional supplements [ 37 , 46 ] and that the majority of people who were not making lifestyle changes were failing to do so because ECP advice had not been provided [ 51 , 56 ]. There was also evidence from one study to suggest that the way in which advice is provided can have a significant impact on outcomes [ 59 ].…”

“…For example, Stevens et al (2014) recruited patients from a voluntary sector patient support group, which may have preferentially included people who were more inclined to engage with the management of their condition [ 58 ]. Thirdly, many of the studies [ 22 , 44 , 45 , 46 , 47 , 51 , 53 , 55 , 56 , 59 , 60 , 61 ] in this review recruited participants from single clinics. This decreases the generalisability of the results as the patients attending one clinic in one city may have different care experiences to patients in other places around the world.…”

Patient Use of Dietary Supplements, Home Monitoring, or Genetic Testing for Nonneovascular Age-Related Macular Degeneration

“…Of note, a prospective survey of concordance with the AREDS recommendations showed high patient concordance rates with verbal and written instructions and verbal repetition from staff members at each visit. 29 Providing written and verbal advice relevant to each patient's stage of AMD in conjunction with continual repetition of instructions may also help reinforce the correct use of AREDS supplementation and home monitoring.…”

Micronutrients and Benefits of Supplementation for Reducing the Risk of Progression of Age-related Macular Degeneration – An Update

“…Intensive patient education including a policy of providing verbal and written instructions along with verbal repetition of these instructions from each staff member on each patient visit could double the adherence to supplementation. 75 To increase the patient adherence, it may be hypothesised that the use of a nutrition oral supplement in orodispersible microgranules, instead of tablets, would improve the assumption. Indeed, the size of tablets, even when small, are not so easy to swallow, which is relevant is certain patient populations, especially the elderly.…”