Intentional and unintentional nonadherence to ocular hypotensive treatment in patients with glaucoma

Ophthalmology. 2010 May;117(5):903-8. doi: 10.1016/j.ophtha.2009.10.038. Epub 2010 Feb 13.


Objective: To determine the rate of intentional and unintentional nonadherence in glaucoma patients and to identify associations between adherence behavior and patients' beliefs.

Design: Cross-sectional study.

Participants: One hundred thirty-one glaucoma patients using topical eye drops for at least 6 months.

Methods: Interviewer-administered surveys.

Main outcome measures: Self-reported adherence and beliefs about glaucoma and its treatment were assessed using the Reported Adherence to Medication scale, the Brief Illness Perception Questionnaire, and the Beliefs about Medicines-Specific Questionnaire.

Results: Overall, 59 (45%) participants reported some degree of nonadherence, among whom 39 (66.1%) reported unintentional nonadherence (e.g., forgetting), 10 (16.9%) reported intentional nonadherence (deliberate nonadherence), and 10 (16.9%) reported both forms of nonadherence. Compared with adherers, nonadherers were significantly younger, were less likely to have other nonocular health conditions or to use medicines other than their eye drops, and reported lower belief in the necessity of eye drops for glaucoma (P<0.05). Degree of unintentional nonadherence was associated with lower belief in necessity of eye drops, whereas degree of intentional nonadherence was associated with concerns about eye drops.

Conclusions: Strategies aimed at improving adherence in glaucoma patients need to address both intentional and unintentional dimensions. Interventions focused on eliciting and addressing patients' beliefs and concerns about their eye drops require evaluation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / administration & dosage*
  • Cross-Sectional Studies
  • Female
  • Glaucoma / drug therapy
  • Glaucoma / psychology*
  • Health Knowledge, Attitudes, Practice*
  • Health Surveys
  • Humans
  • Intraocular Pressure / drug effects*
  • Male
  • Medication Adherence / psychology*
  • Middle Aged
  • Ophthalmic Solutions / administration & dosage
  • Patient Acceptance of Health Care / psychology*
  • Patient Compliance / psychology*
  • Surveys and Questionnaires
  • Young Adult


  • Antihypertensive Agents
  • Ophthalmic Solutions