Can Adherence to Topical Glaucoma Medication be Improved by Using an Audible Alarm?

A Pilot Study


Background Adherence to long-term intraocular pressure (IOP) lowering medication is poor in patients with glaucoma, which is a significant factor in disease progression.

Aim To investigate whether objectively monitored adherence to 0.004% travoprost (Travatan®), an IOP-lowering prostaglandin-analogue eye drop, improves if the audible alarm function of the monitoring device is activated.

Methods Thirty-nine consecutive patients already on self-administered once-daily (evening) travoprost medication for glaucoma received an electronic monitoring device on loan and detailed training on its use. An adherent day was defined as a day with instillation of travoprost (from the monitoring device) at 9:00 pm ± 2 hours. In the first 3-month phase of the investigation, the audible alarm function of the device was disabled, but in the second 3-month period it was activated and set for 9:00 pm. The participants continued using their other eye drops in both phases of the study.

Results Thirty-four participants completed both periods. Non-adherence (mean ± SD) was 18.4 ± 18.9% in the first period and 14.7 ± 18.9% during the second (Wilcoxon signed rank test, p = 0.059). Thus, adherence was 81.6% with the alarm function disabled, and 85.3% when the signal was activated. A significant positive correlation was found between the number of daily eye drop instillations and change of non-adherence (Spearman’s correlation, p = 0.014), showing that when more instillations were used, less marked adherence-improvement was achieved.

Conclusion Though adherence to once-daily topical travoprost medication was satisfactorily high even without the audible alarm function being activated, a nonsignificant tendency for a further improvement of adherence was found when the audible signal was present. For patients who instilled eye drops more frequently, this improvement was significantly less. Our results suggest that using an audible alarm signal set for the time of instillation may have a role in improving adherence in patients with glaucoma who already have relatively good adherence to their medication regimen; however, further studies are required to test this hypothesis.

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    1The use of trade names is for product identification purposes only and does not imply endorsement.


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Dr Holló is supported by a grant from the Hungarian National Health Institute (Grant [ETT] 001/2006). He has also acted as a consultant for Allergan, Alcon, Pfizer, Santen, and Merck Sharpe & Dohme.

Dr Kóthy has no conflicts of interest that are relevant to this paper.

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Correspondence to Dr Gábor Holló.

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Holló, G., Kóthy, P. Can Adherence to Topical Glaucoma Medication be Improved by Using an Audible Alarm?. Pharm Med 22, 175–179 (2008).

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  • Glaucoma
  • Alarm Signal
  • Travoprost
  • Glaucoma Medication
  • Audible Alarm