International Ophthalmology

, Volume 39, Issue 2, pp 375–383 | Cite as

A nationwide survey of factors influencing adherence to ocular hypotensive eyedrops in Japan

  • Toyoaki Tsumura
  • Kenji KashiwagiEmail author
  • Yasuyuki Suzuki
  • Keiji Yoshikawa
  • Hirotaka Suzumura
  • Toshine Maeda
  • Ryuji Takeda
  • Hitomi Saito
  • Makoto Araie
Original Paper



Few reports have investigated the status of adherence in Japan on a large scale. We aimed to investigate the status of adherence to topical glaucoma treatment and its associated factors.


A nationwide survey was conducted as a prospective fashion. Participants in this survey were subjects with primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension or pseudoexfoliation glaucoma who had been prescribed anti-glaucoma ophthalmic eyedrops and whose ophthalmologist considered prescribing any fixed combination of ocular hypotensive eyedrops for the first time between 2011 and 2012. Subjects and their attending ophthalmologists independently completed a questionnaire by utilizing a fixed combination of ocular hypotensive eyedrops.


A total of 1358 ophthalmologists from 1071 medical institutions participated in this survey. We registered 4430 subjects (2049 males and 2381 females). In total, data from 3853 subjects (87.6%) were analyzed after inclusion of subjects based on inclusion and exclusion criteria. Good adherence was defined as not forgetting instillation during the past week. Rates of good adherence reported by subjects and ophthalmologists were 72.4 and 78.5%, respectively (P < 0.0001). The consistency of adherence evaluation between subjects and ophthalmologists was moderate [kappa score 0.5025 (95% confidence interval 0.4740–0.5309)]. Significant factors associated with adherence were size of clinic, age, gender, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma.


Adherence to ocular hypotensive eyedrops among Japanese subjects was relatively good. Concordance of adherence between subjects’ reports and ophthalmologists’ responses was moderate. Size of clinic, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma were associated with adherence among Japanese glaucoma subjects.


Adherence Eyedrops Fixed combination Glaucoma Intraocular pressure Japan 



The authors deeply appreciate the cooperation of the participating subjects and ophthalmologists. Kenji Kashiwagi MD, PhD has full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors have no proprietary or commercial interests in any materials discussed in this article. Pfizer Japan Inc. financially supported this study, but Pfizer Japan Inc. had no roles in designing or conducting the study; collecting, managing, analyzing, or interpreting the data; or preparing, reviewing, or approving the manuscript.

Conflict of interest

The authors have no proprietary or commercial interests in any materials discussed in this article.

Supplementary material

10792_2018_820_MOESM1_ESM.pdf (188 kb)
Supplementary material 1 (PDF 187 kb)
10792_2018_820_MOESM2_ESM.pdf (202 kb)
Supplementary material 2 (PDF 202 kb)
10792_2018_820_MOESM3_ESM.pdf (171 kb)
Supplementary material 3 (PDF 171 kb)
10792_2018_820_MOESM4_ESM.pdf (239 kb)
Supplementary material 4 (PDF 238 kb)


  1. 1.
    Heijl A, Leske MC, Bengtsson B et al (2002) Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol 120(10):1268–1279CrossRefGoogle Scholar
  2. 2.
    Kashiwagi K (2010) Changes in trend of newly prescribed anti-glaucoma medications in recent 9 years in a Japanese local community. Open Ophthalmol J 4:7–11CrossRefGoogle Scholar
  3. 3.
    Okeke CO, Quigley HA, Jampel HD et al (2009) Adherence with topical glaucoma medication monitored electronically the Travatan Dosing Aid study. Ophthalmology 116(2):191–199CrossRefGoogle Scholar
  4. 4.
    Campbell JH, Schwartz GF, LaBounty B et al (2014) Patient adherence and persistence with topical ocular hypotensive therapy in real-world practice: a comparison of bimatoprost 0.01% and travoprost Z 0.004% ophthalmic solutions. Clin Ophthalmol 8:927–935CrossRefGoogle Scholar
  5. 5.
    Nordstrom BL, Friedman DS, Mozaffari E et al (2005) Persistence and adherence with topical glaucoma therapy. Am J Ophthalmol 140(4):598–606CrossRefGoogle Scholar
  6. 6.
    Park MH, Kang KD, Moon J (2013) Noncompliance with glaucoma medication in Korean patients: a multicenter qualitative study. Jpn J Ophthalmol 57(1):47–56CrossRefGoogle Scholar
  7. 7.
    Kashiwagi K, Furuya T (2014) Persistence with topical glaucoma therapy among newly diagnosed Japanese patients. Jpn J Ophthalmol 58(1):68–74CrossRefGoogle Scholar
  8. 8.
    Reardon G, Kotak S, Schwartz GF (2011) Objective assessment of compliance and persistence among patients treated for glaucoma and ocular hypertension: a systematic review. Patient Prefer Adherence 5:441–463CrossRefGoogle Scholar
  9. 9.
    Gray TA, Fenerty C, Harper R et al (2012) Individualised patient care as an adjunct to standard care for promoting adherence to ocular hypotensive therapy: an exploratory randomised controlled trial. Eye (London) 26(3):407–417CrossRefGoogle Scholar
  10. 10.
    Quek DT, Ong GT, Perera SA et al (2011) Persistence of patients receiving topical glaucoma monotherapy in an Asian population. Arch Ophthalmol 129(5):643–648CrossRefGoogle Scholar
  11. 11.
    Owen CG, Carey IM, de Wilde S et al (2009) Persistency with medical treatment for glaucoma and ocular hypertension in the United Kingdom: 1994–2005. Eye (London) 23(5):1098–1110CrossRefGoogle Scholar
  12. 12.
    Djafari F, Lesk MR, Harasymowycz PJ et al (2009) Determinants of adherence to glaucoma medical therapy in a long-term patient population. J Glaucoma 18(3):238–243CrossRefGoogle Scholar
  13. 13.
    Gurwitz JH, Glynn RJ, Monane M et al (1993) Treatment for glaucoma: adherence by the elderly. Am J Public Health 83(5):711–716CrossRefGoogle Scholar
  14. 14.
    Robin AL, Covert D (2005) Does adjunctive glaucoma therapy affect adherence to the initial primary therapy? Ophthalmology 112(5):863–868CrossRefGoogle Scholar
  15. 15.
    Robin AL, Novack GD, Covert DW et al (2007) Adherence in glaucoma: objective measurements of once-daily and adjunctive medication use. Am J Ophthalmol 144(4):533–540CrossRefGoogle Scholar
  16. 16.
    Aptel F, Denis P (2011) Balancing efficacy and tolerability of prostaglandin analogues and prostaglandin-timolol fixed combinations in primary open-angle glaucoma. Curr Med Res Opin 27(10):1949–1958CrossRefGoogle Scholar
  17. 17.
    Herceg M, Noecker R (2008) Travoprost/timolol fixed combination. Expert Opin Pharmacother 9(6):1059–1065CrossRefGoogle Scholar
  18. 18.
    Higginbotham EJ (2010) Considerations in glaucoma therapy: fixed combinations versus their component medications. Clin Ophthalmol 4:1–9Google Scholar
  19. 19.
    Sabaté E (2003) Adherence to long-term therapies: evidence for action. World Health Organization, GenevaGoogle Scholar
  20. 20.
    Cate H, Bhattacharya D, Clark A et al (2014) Improving adherence to glaucoma medication: a randomised controlled trial of a patient-centred intervention (The Norwich Adherence Glaucoma Study). BMC Ophthalmol 14:32CrossRefGoogle Scholar
  21. 21.
    Dreer LE, Owsley C, Campbell L et al (2016) Feasibility, patient acceptability, and preliminary efficacy of a culturally informed, health promotion program to improve glaucoma medication adherence among African Americans: “Glaucoma Management Optimism for African Americans Living with Glaucoma” (GOAL). Curr Eye Res 41(1):50–58CrossRefGoogle Scholar
  22. 22.
    Loon SC, Jin J, Jin Goh M (2015) The relationship between quality of life and adherence to medication in glaucoma patients in Singapore. J Glaucoma 24(5):e36–e42CrossRefGoogle Scholar
  23. 23.
    Rosdahl JA, Swamy L, Stinnett S et al (2014) Patient education preferences in ophthalmic care. Patient Prefer Adherence 8:565–574CrossRefGoogle Scholar
  24. 24.
    Kashiwagi K, Tsukahara S (2014) Impact of patient access to Internet health records on glaucoma medication: randomized controlled trial. J Med Internet Res 16(1):e15CrossRefGoogle Scholar
  25. 25.
    Friedman DS, Okeke CO, Jampel HD et al (2009) Risk factors for poor adherence to eyedrops in electronically monitored patients with glaucoma. Ophthalmology 116(6):1097–1105CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Toyoaki Tsumura
    • 1
    • 2
  • Kenji Kashiwagi
    • 2
    Email author
  • Yasuyuki Suzuki
    • 3
  • Keiji Yoshikawa
    • 4
  • Hirotaka Suzumura
    • 5
  • Toshine Maeda
    • 6
  • Ryuji Takeda
    • 7
  • Hitomi Saito
    • 8
  • Makoto Araie
    • 8
  1. 1.Fussa HospitalTokyoJapan
  2. 2.Department of Ophthalmology, Faculty of MedicineUniversity of YamanashiChuoJapan
  3. 3.Department of OphthalmologyTokai UniversityHiratsukaJapan
  4. 4.Yoshikawa Eye ClinicTokyoJapan
  5. 5.Suzumura Eye ClinicTokyoJapan
  6. 6.Maeda Eye ClinicTokyoJapan
  7. 7.Faculty of AgricultureKinki UniversityNaraJapan
  8. 8.Kanto Central Hospital of the Mutual Aid Association of Public SchoolTokyoJapan

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