Home' Australian Pharmacist : Australian Pharmacist February 2011 Contents Vol. 30 -- February #02
Continuing Professional Development
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
carried out to test the sensitivity of
the side of the fields of vision as well
as testing to determine any damage to
the optic nerve.6
A recent Cochrane review looked
at eight studies which aimed to
determine different methods to help
people to use their eye drops as
prescribed and found that a large
number of people do not use eye drops
as prescribed.7 The review found that,
'approximately 70% of people who are
prescribed eye drops for the first time,
fail to continue collecting prescriptions
within the first year and even when
patients collect prescriptions they do
not always use the drops as frequently
as they should'.7 As non-adherence
may refer to either the intentional or
accidental failure of a patient to follow
a doctor's directions, non-adherence
to ophthalmic medications must be
explored by the pharmacist in order
to implement effective strategies for
The pharmacist ideally placed to
promote early diagnosis, but is also well
placed to promote adherence among
patients being treated for glaucoma.
Various studies have shown that use
of eye drops increases on the days just
before seeing the doctor, therefore
progressive visual loss may occur due
to non-adherence between visits even if
the doctor finds a 'safe' IOP at the time
of consultation.7, 8 A constant theme
surrounding health care provision is that
education is key. Misconceptions about
the condition and its treatment are the
rule among glaucoma patients, not the
exception. Strategies which may be
employed by the pharmacist to enhance
adherence with medical therapy in
glaucoma are to assist in minimising
inconvenience, teaching instillation
techniques and offering information.
Reasons for accidental non-adherence
should be explored, such as elderly
patients with arthritis and/or tremor who
find eye drop instillation difficult. In one
survey, 27% of glaucoma patients failed
to place the drop into the conjunctival
sac, and of these, 25% were unaware
that they had missed the eye.7
Current studies remain inconclusive
regarding particular recommendations
to increase ophthalmic medication
adherence. Five of the eight studies
explored in the Cochrane review found
that certain interventions helped
people to use their eye drops reliably,
these included simplifying drop
routines, reminder devices, providing
information about glaucoma and
offering advice regarding day to day
issues with eye care.7
Of particular interest for pharmacists
is an Australian study into adherence
with medical therapy in glaucoma. It
found that patients taught instillation
techniques did better than those who
weren't, particularly if the instructions
were repeated periodically.8
At present, 50% of people
with glaucoma in Australia are
undiagnosed.2 This condition could be
affecting every second person who
walks through the pharmacy door.
World Glaucoma Week is a national
awareness campaign running from
6--12 March -- an ideal time to educate
patients about their eye health. This
campaign aims to raise awareness
of this 'silent' eye condition and is
a timely reminder to undertake an
eye check as early diagnosis and
appropriate treatment are paramount
in saving vision from glaucoma2.
For more information, visit Glaucoma
Australia at: www.glaucoma.org.au
1. Anderson DM, Keith J, Novak PD, Elliot MA. Mosby's
medical, nursing and allied health dictionary. 6th Edn.
2. Glaucoma Australia Inc. [accessed 3 Dec 2010];
3. Walland MJ. Glaucoma treatment in Australia:
Changing patterns of therapy 1994--2003. Clin
Experiment Ophthalmol 32:590--6.
4. eTherapeutic Guidelines: Neurology. 2007. Glaucoma.
[accessed 3 Dec 2010].
5. Australian Medicines Handbook. 2010. Drugs for
Glaucoma [online -- accessed 3 Dec 2010];
6. The Royal Australian and New Zealand College of
Ophthalmologists. [accessed 3 Dec 2010];
7. Gray TA, Orton LC, Henson D, Harper R, Waterman
H. Interventions for improving adherence to ocular
hypotensive therapy. Cochrane Database of Systematic
Reviews 2009, Issue 2. Art. No: CD006132. DOI:
8. Goldberg, I. The medical treatment of glaucoma. Aust
1. Which of the following
statements does not relate to
a) The condition is often referred to
as closed-angle glaucoma.
b) In this type of glaucoma, people
suffer pain and nausea.
c) Is the most common type of
glaucoma in Australia.
d) The pressure inside the eye
2. Which of the following patients
would be most at risk of
a) 35-year-old with latino ancestry.
b) 40-year-old with no previous
c) 30-year-old with a history
3. A 40-year-old man has had an
elevated IOP measured during
a regular eye exam. Which of
the following will be the next
step taken in relation to his
a) His iris will be measured
in preparation for laser
trabeculoplasty whereby excess
fluid will be drained.
b) Further testing will be carried out
to test his visual fields.
c) He will be prescribed ophthalmic
medications to control his IOP.
d) He will be referred for a
second IOP measurement in
three months time.
A score of 3 out of 4 attracts 0.75 CPD credits.
4. Which of the following
will best aid adherence in
a) Printing a CMI on new ophthalmic
b) Education on the condition.
c) Asking if a patient has regular
d) Suggesting medications with a
different dosing frequency.
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