Volume 15, Number 1
April 2006
Adherence to Medical Therapy: Why is it
so Hard?
Nancy Petrongolo
Dr. L. Jay Katz, co-director of the Glaucoma Service, has been
studying the effects of poor adherence to medical treatments.
He believes that non-adherence with medical therapy is an obstacle
to providing the best care for patients at risk for visual loss
and is studying effective ways to help patients maintain recommended
therapy. I asked Dr. Katz some questions about this issue.
What is adherence and compliance?
Dr. Katz: Adherence and compliance are terms
used to describe how patients follow their doctors' recommendations
on using their medications. It is estimated that only 50% of patients
correctly follow those instructions. There are different types
of nonadherence. For example: too little or too much medication,
skipping days, and taking medication at the wrong time.
Why don't patients follow the recommendations?
Dr. Katz: There are many potential
reasons.
- Some people don't understand that untreated glaucoma may
lead to irreversible blindness and that the treatment with eye
drops is life-long and is not a cure.
- Some patients cannot get the drops into their eyes.
- Some patients may forget to carry their medications with
them or to use them as directed.
- Some patients are unclear if the medications work since they
don't see any signs of improvement.
- Some patients can't afford to buy their medicine like when
they run out before they are eligible for a refill.
- Some patients have side effects when using glaucoma medications
and they stop using or reduce the dosage to minimize the side
effects.
- Some patients have difficulty juggling the dosing schedule
or using multiple bottles.
Why is adherence to medical therapy
so important?
Dr. Katz: Many patients are losing vision
because their doctors are unaware that patients are nonadherent.
That partially explains why some people still go blind from glaucoma.
How do you measure patient adherence?
Dr. Katz: Several studies have measured the effect
of adherence to glaucoma therapy. Some of the methods used to
discover the level of adherence include patient questionnaires,
pharmacy refill records, physician judgment and electronic monitoring.
In addition to providing information on the extent of the problem,
these studies offer insights that may help us improve adherence.
What can a patient do?
Dr. Katz:
- Make sure you understand why you are being treated and what
that treatment is supposed to do.
- Know how to put eye drops in properly.
- If the dosage or numbers of medications is too complicated
and you can't follow that schedule, speak up and tell your doctor.
- If side effects are not tolerable and it makes using the
medication on a daily basis difficult, tell your doctor so that
maybe another medication may be tried.
- Explain to your doctor any financial limitation you may have
in buying the medication on a regular basis. Some medications
are less expensive than others and may work as well.
- If you are forgetful, then use an alarm clock or alarm watch
to help remind you to take your medications. There are free,
commercially available reminder aids for certain medications.
Clearly, non-adherence and noncompliance are obstacles to patients
receiving the best care. Physicians and patients must work together
to address this issue.
Letter from the Executive Director
 Dear
Friends,
As you may know, January is Glaucoma Awareness Month. We here
at the Glaucoma Service Foundation have been very busy promoting
glaucoma awareness, as you will see in the In the News
section of this issue. However, glaucoma is a disease that deserves
awareness every month. So we are initiating
the Family Awareness Campaign. Family members of glaucoma patients
are at higher risk of developing glaucoma at an earlier age. That
is why we need your help in the battle against glaucoma. Please
speak with your family members and encourage them to see an ophthalmologist
to have a dilated eye examination. When glaucoma is detected early,
vision can be saved. More people need to know about glaucoma and
its risks, so that less people will lose their precious sight!
Please work with us to help prevent blindness from glaucoma. Talk
to your family today. Together we can make a difference!
Sincerely,
Nancy Petrongolo
Executive Director
Welcome Dr. Tricia Lennox Thomas
We are extremely pleased to announce that Dr.
Tricia Lennox Thomas will be joining the Glaucoma Service at Wills
Eye and the Spaeth/Katz/ Myers practice. Dr. Thomas has long been
in this area, having graduated with honors from Princeton University,
and having completed her medical degree at Thomas Jefferson University.
Dr. Thomas was outstandingduring her residency training at Wills
Eye Hospital, being noted for her warm bedside manner and excellent
medical knowledge and surgical skills. She later went on to the
distinguished New York Eye and Ear Infirmary for fellowship training
in glaucoma. Since her fellowship, Dr. Thomas has been in practice
in Bucks County, and she is now excited to return to Wills Eye
Hospital to join the glaucoma staff.
The Foundation Mourns the Loss of
Board Member, David Eastburn
The Foundation is sad to report the passing last
October of Board member Mr. David Eastburn. Mr. Eastburn was a
patient of Dr. George Spaeth and brought to the Foundation the
considerable wisdom gained in his distinguished career.
Mr. Eastburn was a graduate of Newtown and Amherst College and
received his doctorate degree from the Wharton School at the University
of Pennsylvania. His professional career began with the Federal
Reserve Bank of Philadelphia in 1942 in the research department.
He held various positions there and was eventually senior vice
president of research until March 1, 1970, when he became the
President of the Federal Reserve Bank of Philadelphia.
Mr. Eastburn had also been an instructor of finance at the University
of Pennsylvania and lecturer at the Graduate School of Banking
at Rutgers University and the University of Wisconsin. After retiring
from the Federal Reserve Bank, he served on many boards including
the Van Guard Group, the Glaucoma Service Foundation, the United
Way and the Philadelphia Orchestra and was a member of the American
Philosophical Society. In September 2001, Mr. Eastburn was presented
with the prestigious Philadelphia Orchestra Award for his visionary
leadership and dedicated years of service. He also founded the
Bucks County Symphony and was an active member until his death.
Commenting on Mr. Easburn, Dr. Spaeth said, “Mr. Eastburn
was a tremendous help to the Glaucoma Service Foundation. His
assistance in setting up the proper financial procedure transformed
the way the Foundation operated. His help was offered in a way
that was gracious and supportive. It was at his suggestion we
had the first real audit of the Glaucoma Service Foundation to
Prevent Blindness. With his help, the financial operations of
the Glaucoma Service Foundation have become rock solid. Each year
the auditors give us high grades. This would not have been possible,
and in fact would not have occurred, without Mr. Eastburn's help.
Mr. Eastburn was always available to give us advice. Mrs. Petrongolo
or I would call him about a variety of different issues, and the
response would always be the same: first, a welcoming voice and
a comment that of course he had time to talk to us; second, absolute
quiet while the issue was being presented to him; third, a few
penetrating questions that clarified the issue more fully; and,
finally, some sage advice that was always appropriate and always
helpful. He had a sense of what was possible and what was not
possible, and also what was necessary and what was not necessary.
I will miss Mr. Eastburn, not only for his advice, which was based
on years of experience, deep knowledge and keen insight, but also
for his gracious manner. He was and will continue to be a role
model for me, and I am sure for many others.”
HELPFUL TIPS FOR PATIENTS WITH
GLAUCOMA
(FROM DR. ELLIOT WERNER)
Question: How can
you prevent bubbles from forming and bursting when you are dispensing
your
eye drops?
Answer: Try holding
the bottle upside down with the cap on for a moment before putting
the drop in
your eye.
Question: When the
cap on the bottle is removed to instill drops, should the cap
be laid on its side or upright?
Answer: The cap
should be laid upright, on the flat bottom, since the lip of the
cap doesn't touch the
dropper tip. That will prevent dust or dirt from getting into
the cap.
IN THE NEWS
The Foundation's Public Relations Committee launched
a public awareness campaign in January that is expected to run
through June. To date the Foundation has received the following
media coverage about glaucoma, the need for regular dilated eye
examinations, and Foundation sponsored programs:
- On February 15th, Dr. Jonathan Myers and Nancy Petrongolo
along with glaucoma patient, Ms. Elizabeth Kennedy, were guests
on WDAS 1480 AM with host Yanina Carter.
- Dr. George L. Spaeth was interviewed on CN8's Your Morning
on February 2nd.
- Carla Showell-Lee host of Comcast Newsmakers interviewed
Foundation Executive Director Nancy Petrongolo.
- An article in the Philadelphia Tribune by Ayana Jones on
January 31st.
- An article in the Philadelphia Daily News by Drs. Spaeth,
Katz and Myers on January 26th.
- Nancy Petrongolo was a guest of WYSP radio host Jim Tayoun
on January 22nd.
- Dr. George Spaeth was interviewed on WURD radio by host Eleanor
Dezzi on January 19th.
Through the efforts of glaucoma patient Deborah
Dolnick, it was resolved that the House of Representatives designated
the month of January 2006 as "Glaucoma Awareness Month"
in Pennsylvania to help develop greater public awareness of the
importance of medical eye care for the citizens of Pennsylvania.
We would like to thank Deborah for her efforts in proposing and
pursuing passage of this resolution through her State Representative!
Foundation Board member, Mr. Stephen Harmelin, was honored by
HOBY (Hugh O'Brian Youth Leadership) as they celebrated “Great
Leaders: Past, Present and Future” at a dinner in New York
on January 30, 2006. Mr. Harmelin received the Albert Schweitzer
Leadership Award for his work with the National Constitution Center
in recovering an original copy of the Bill of Rights and returning
it to North Carolina. Congratulations Mr. Harmelin!
Brigit High, a high school student and granddaughter of a Glaucoma
Service patient, recently held a bake sale/fundraiser - Cakes
For Sight. She donated all funds collected to the Glaucoma Service
Foundation to Prevent Blindness in an effort to promote glaucoma
awareness. Thank you Brigit!
AIGPO (Association of International Glaucoma Patient Organizations)
is a newly founded world-wide organization whose members serve
as advocates to encourage ophthalmologists and their patients
to develop glaucoma support groups around the world. Our webmaster,
Vivian Werner, is providing assistance in structuring these much
needed groups. Great work Viv!
Recent Support Group Meeting/ Lecture Series
February 26, 2006
Common Mistakes Patient Make
Richard P. Wilson, MD
March 19, 2006
Current Research on New Surgery for Glaucoma
Jonathan S. Myers, MD
April 23, 2006
Adherence to Medical Therapy
L. Jay Katz, MD
Upcoming Support Group Meeting/ Lecture Series
Date: May 21, 2006
Time: 1:30 - 3:00 PM
Place: Wills Eye 8th Floor Auditorium
Speaker: TBA
Topic: Helping Your Doctor Help You!
Wills Glaucoma Conference Features Past Fellows of the
Glaucoma Service
The Annual Conference of the Wills Eye Glaucoma Service
was held in Philadelphia on February 3-4, 2006. Many of
the fellows who trained here on the Glaucoma Service returned
to discuss the fact that glaucoma is the leading cause of
irreversible blindness and that much of that blindness can
be prevented with early detection.
The global nature of the problem was addressed, pointing
out that half of the people who have glaucoma are never
diagnosed! There were many detailed discussions regarding
the scope of glaucoma, diagnosis, treatment and outcome
measures. Central to the whole conference was the trust
the ex-fellows have in each other and in each other's professional
abilities. This allowed for frank and open discussions.
This year's Barnshaw Lecture was given by Dr.M. Francesca
Cordeiro, whose talk, Visualizing Individual Retinal Ganglion
Cells in Health and Disease, was a high point of the Conference.
Dr. Cordeiro has developed a method of marking the cells
in the retina that are damaged or killed in people with
glaucoma. These cells can be seen in the living person by
using a very high-resolution imaging. Thus, she is developing
a technology that will allow knowing exactly how much damage
glaucoma has caused, and whether the glaucoma is staying
the same or getting worse. This ability will result in a
dramatic improvement in fitting appropriate treatment to
each individual.
Over 100 physicians from the United States and Canada attended
the two-day conference, some who trained here on the Glaucoma
Service, and many who were interested in learning from leaders
in the field.
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The International Society of Spaeth Fellows
honored Dr. George Spaeth at the Wills
Glaucoma Conference by presenting him with a portrait by
New York artist Irene Hecht.
Ex-fellows Dr. Courtland Schmidt, Dr. Michael Stiles and
Dr. Fred Orlando
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Ex-fellows Dr. Paul Harasymowycz, Dr. Leslie
Jones, Dr. Lorenzo Pecora, and Dr. Sai Gandham
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Ex-fellows Dr. Steve Simmons, Dr. Dan Nichols
and Dr. Jonathan Myers discuss Dr. Myers'
presentation on electronic medical records. |
Ex-fellow Dr. Mary Jude Cox, Wills Eye Resident,
Dr. Bhairavi Kharod, Ex-fellow, Dr. Heather Nesti
and Ex Wills resident, Dr. Carrie Cutney.
(Photos by Nancy Petrongolo)
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Glaucoma Service Director Receives
Visionary Award
 The
Bausch & Lomb Visionary Award was presented to Dr. George
L. Spaeth on October 16, 2005 in Chicago, Illinois during the
annual American Academy of Ophthalmology meeting by Bausch &
Lomb's President of the Americas Region, Mr. Paul Howes.
When presenting Dr. Spaeth with the award, Mr. Howes said, "The
Bausch & Lomb Visionaries Recognition Program is a landmark
initiative that was designed to recognize outstanding individuals
within the eye care industry. Nominated by his peers and reviewed
by an independent, blue-ribbon panel of industry thought leaders,
the honoree will receive a $20,000.00 donation to the vision-related
charities of his choice. We would like to take this opportunity
tonight to honor the ophthalmologist who has been nominated by
his peers and designated as a visionary by the independent selection
committee - Dr. George Spaeth."
"As a visionary honoree, Dr. Spaeth has designated the Glaucoma
Service Foundation to Prevent Blindness as the vision-related
charity of his choice, and Bausch & Lomb has made a donation
of $20,000.00 to this Foundation on behalf of Dr. Spaeth."
Current and previous recipients of the award include: H. Dwight
Cavanagh, M.D., Ph.D., University of Texas Southwestern Medical
Center, Dallas; Richard M. Hill, O.D., Ph.D., Ohio State University,
Columbus; Donald R. Korb, O.D., Korb & Associates, Boston;
Eleanor E. Faye, M.D., Lighthouse International, New York, New
York; Bradley R. Staatsma, M.D., Jules Stein Eye Institute, Los
Angeles, California; Michael T. Trese, M.D., Associated Retinal
Consultants, Royal Oak, Michigan; George O. Waring, III, M.D.,
InView Vision, Atlanta, Georgia; and Karla Zadnik, O.D., Ph.D.,
of the Ohio State University, College of Optometry.
Dr. Spaeth stated that he was honored to be included in the company
of such a diverse and accomplished group and congratulated Bausch
& Lomb on their contributions and their vision in supporting
research.
Glaucoma Research Center Update
The Glaucoma Research Center is actively involved
in studies to improve treatment strategies for people with glaucoma.
Studies include:
- Investigating various new surgical devices.
- Examining the safety and efficacy of certain investigational
eye drops.
- Looking at how major eye diseases affect an individual’s
ability to function regarding the tasks of daily living.
- Comparing various glaucoma medications to see which work best
in lowering intraocular pressure.
If you are interested in participating in a research study,
please talk to your doctor to see if you qualify. For more information,
please call the Glaucoma Research Center at (215) 928-3123.
Continuing
To Make a Difference!
We are extremely grateful to the many friends
and supporters of the Glaucoma Service Foundation to Prevent Blindness.
During calendar year 2005 more than 1400 individuals, foundations,
estates, and corporations donated a total of $343,643.00 to support
the Foundation's work.
We value every gift, since each contribution reflects confidence
in our efforts to better understand and treat glaucoma in addition
to helping those living with this potentially blinding disease
through education and support.
A recent study showed the number of people who are blind or have
low vision due to glaucoma is expected to rise by 50% over the
next 15 years. However, this significant rise in disability can
be avoided with new strategies for prevention, diagnosis and treatment,
which make the need for funding of the Foundation's education,
outreach, and research programs even more critical.
To all of our donors and volunteers, THANK YOU FOR YOUR
EXTRAORDINARY GENEROSITY!
With your continued help, our goal - to end blindness from glaucoma
- is within our reach!
Participant: Dr. Henderer, many of the patients
in the chat room tonight who are in their 50s thought glaucoma
was a disease of the elderly.
Dr. Jeff Henderer: Excellent point. Glaucoma
can occur at any age. Most of the time the risk for glaucoma starts
to go up as the reading vision begins to wane, around age 40.
That means people will be heading to the eye doctor anyway, so
we can examine them for glaucoma then. Family history plays a
big role in identifying those who may develop the disease earlier
in life.
Participant: What role do the
new image analyzer machines play in managing glaucoma?
Dr. Jonathan Myers: Many doctors are now using
the machines to supplement their examinations. The machines can
confirm suspicions of pathology, and often may alert the doctor
to subtle missed clues to problems. So far, the machines have
not been shown sufficient to replace the doctor's careful examination
of the optic nerve or the visual field test.
Participant: Can you cite an example of a subtle
clue that a doctor might miss, but a machine may detect?
Dr. Jonathan Myers: Sometimes, small areas of
damage, such as a notch, or tint defect, in just one area of the
nerve, can be hard to appreciate on routine examination. The machine
may pick this up, make it obvious on the printout, and allow the
doctor to look back at the patient, and then at the notch. On
the other hand, a disc hemorrhage, a tiny spot of blood on the
optic nerve, is also a sign that the glaucoma may be worsening.
None of the current machines will detect disc hemorrhages, but
the doctor can see them on careful examination of the nerve. That's
why the doctor and the machine complement each other.
Participant: What are the different
classes of glaucoma drugs and how do they differ?
Dr. Elliot Werner: There are two classes of drugs,
miotics (pilocarpine, carbachol) and prostaglandins
(Xalatan, Travatan, Lumigan) that lower intraocular pressure by
increasing outflow; that is they move the fluid out of
the eye faster. The beta blockers (timolol, Betagan, Betoptic),
adrenergics (epinephrine, Alphagan, brimonidine)
and carbonic anhydrase inhibitors (Diamox, Timoptic, Azopt, Neptazane)
lower intraocular pressure by decreasing
the amount of fluid the eye produces.
CHAT SUPPORT
GROUP
www.willsglaucoma.org
Wednesdays, 8:30-9:30 pm
Hosted by a Wills Glaucoma Specialist
Mondays, 8:00-9:30 pm
Patients and family members only
Sundays, 8:30-10 am
Parents chat
Saturdays, 10 am
Fun chat
Current and archived chat highlights are available
for review on our website www.willsglaucoma.org.
If you do not have access to a computer, call the Foundation
to have a printed copy mailed to you. If you are interested in
a specific topic please let us know.
 Glaucoma
Service Research Fellow from Brazil
Dr. Renata DaSilva, from Rio de Janeiro, Brazil, is spending
six months on the Glaucoma Service as a Research Fellow. Dr. DaSilva
received her glaucoma training at Hospital da Piedade with Dr.
Sergio Meirelles and Instituto Benjamin Constant with Dr. Mauro
Albuquerque. She is working with Dr. Spaeth on a new surgical
study. In addition to her research, Dr. DaSilva is excited to
have the opportunity to learn about the Disc Damage Likelihood
Scale and the Gonioscopy Grading System.
(Photo by Nancy Petrongolo)
SHARING INFORMATION
If you have practical tips for dealing with the challenges facing
glaucoma patients, please write or email the Foundation office.
Innovative ideas may be included in future issues of Searchlight
and on our website.
Thank you!
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