The Impact of the Coronavirus Disease 2019 Pandemic on Adherence to Ocular Hypotensive Medication in Patients with Primary Open-Angle Glaucoma

Abstract

Objective Emerging evidence suggests that the COVID-19 pandemic is disrupting health behaviors such as medication adherence. The objective of this study was to determine whether adherence to ocular hypotensive medication was affected by the pandemic and to identify factors associated with this change. Design In this cohort study, we used a controlled interrupted time series design in which the interruption was the declaration of the COVID-19 pandemic in the United States on March 13, 2020. The 300-day monitoring period, which evenly bracketed this declaration, started on October 16, 2019, and ended on August 10, 2020. Participants Patients with primary open-angle glaucoma enrolled in an ongoing longitudinal NIH-funded study initiated prior to the onset of the pandemic were selected if they were prescribed ocular hypotensive medication and had adherence data spanning the 300-day period. Methods We applied segmented regression analysis using a “slope change following a lag” impact model to obtain the adherence slopes in the periods preceding and following the segmentation. We compared the two slopes using the Davies test. Main outcome and measure The main outcome measure was daily adherence to ocular hypotensive medication—defined as the number of doses taken divided by the number of doses prescribed, expressed in percent. Adherence was measured objectively using Medication Event Monitoring System (MEMS) caps. We assessed the associations between change in adherence and demographic, clinical, and psychosocial factors. Results The sample included 79 patients (mean age, 71 years [SD, 8 years]). Segmented regression identified a breakpoint at day 28 following the declaration of the pandemic. The slope in the post-breakpoint period (-0.04%/day) was significantly different from zero ( P < 0.001) and from the slope in the period preceding the breakpoint (0.006%/day) ( P < 0.001). A significant positive association was observed between the Connor-Davidson Resilience score and the change in slope between the pre- and post-breakpoint periods ( P = 0.002). Conclusions and Relevance Adherence to ocular hypotensive medication worsened during the COVID-19 pandemic and appears to be related to patient resilience. This collateral consequence of the pandemic may translate into vision loss that may manifest beyond its containment.

The medication adherence among glaucoma patients during the coronavirus disease 2019 pandemic in Croatia

“…18 Raccete et al reported a worsening of treatment adherence estimated objectively by using Medication Event Monitoring System (MEMS) caps in glaucoma patients in the US, documenting an adverse impact of the COVID-19 outbreak on health behaviour, which places patients at risk of vision loss. 25 On the other hand, the study conducted in Enugu, Nigeria, revealed that the pandemic did not reduce adherence to follow-up appointments but revealed the continued low rate of adherence in the system. 22…”

“…18 Raccete et al reported a worsening of treatment adherence estimated objectively by using Medication Event Monitoring System (MEMS) caps in glaucoma patients in the US, documenting an adverse impact of the COVID-19 outbreak on health behaviour, which places patients at risk of vision loss. 25 On the other hand, the study conducted in Enugu, Nigeria, revealed that the pandemic did not reduce adherence to follow-up appointments but revealed the continued low rate of adherence in the system. 22 The present study showed that the main patients' sociodemographic factors were not associated with adherence to treatment in the final regression analysis, except the educational level, which was significantly positively correlated to adherence.…”

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“…In particular, patients with glaucoma followed during the pandemic presented lower adherence to ocular hypotensive medication. 32 In our study, up to eight patients were tested positive on nasopharyngeal swabs between M2 and M5 and could not attend the control visit. Taking into account the post-surgical context and relative short duration of the treatment compared to glaucoma therapy, as well as the high rate of adherence observed in the cohort and the clearly distinguishable patients’ profiles, the impact of COVID-19 pandemic on the adherence may be considered negligible whereas it clearly impacted the participation of patients to follow-up visits.…”

Changes to glaucoma surgery patterns during the coronavirus disease 2019 pandemic: a shift towards less invasive procedures

“…Patients who qualified for surgeries during the pandemic had significantly higher IOP values than those who qualified before the pandemic. This may be due to a previously reported decline in adherence to ocular hypotensive medication during the COVID-19 pandemic [ 26 ]. However, OCT examinations revealed that an increased IOP did not affect the pathological stage of glaucomatous neuropathy.…”