What are the recommendations for patient education and health promotion in open angle glaucoma management?

Patient Education and Health Promotion in Open Angle Glaucoma Management

Patient education and engagement are essential components of open angle glaucoma management, focusing on disease understanding, medication adherence, and proper administration techniques to improve outcomes related to morbidity, mortality, and quality of life.

Key Educational Components

Disease Understanding

• Patients should receive clear information about glaucoma as a disease process, including its potential to cause irreversible vision loss if not properly managed 1
• Education should be provided through multiple formats: in-person discussions, written materials, and online resources to accommodate different learning preferences 1
• Patients with poor health literacy may require simplified explanations with limited dense text and "teach-back" techniques to ensure comprehension 1

Medication Adherence Strategies

• Poor adherence to glaucoma therapy is well-documented, with studies showing nearly 45% of patients take fewer than 75% of prescribed doses despite receiving instruction and free medication 1
• Strategies to improve adherence include:
  • Linking eye drop administration to daily activities 1
  • Providing clearly written medication regimens 1
  • Using follow-up telephone calls or smartphone reminders 1
  • Considering fixed-combination medications to reduce the number of drops required 1
  • Discussing medication costs, as this can be a significant barrier to adherence 1

Proper Medication Administration

• Patients should be educated about eyelid closure and nasolacrimal occlusion techniques to reduce systemic absorption of medications 1
• Repeated instruction on proper drop instillation techniques is necessary, as many patients struggle with administration, particularly as they age or as glaucoma progresses 1
• For patients who cannot reliably administer drops, alternative treatments such as laser trabeculoplasty should be considered 1

Psychological Support and Quality of Life

• Ophthalmologists should be mindful that a glaucoma diagnosis can cause negative psychological effects and fear of blindness 1
• Education should address quality of life concerns including:
  • Employment issues (fear of job loss due to vision impairment) 1
  • Social isolation concerns 1
  • Loss of independence and impact on daily activities 1
• Some patients may benefit from peer-support groups or counseling 1

Special Considerations

Pregnancy and Breastfeeding

• Patients who are pregnant or breastfeeding require special counseling about medication risks and benefits 1
• Medication categories and safety profiles should be discussed, with beta-blockers often used during pregnancy due to long-term experience with this class 1
• Prostaglandins are generally avoided during pregnancy due to theoretical risk of premature labor 1

Keratorefractive Surgery

• Patients considering laser vision correction should be informed about potential impacts on contrast sensitivity and IOP measurement accuracy 1

Follow-up Education

• At each follow-up visit, medication dosage and frequency should be recorded and reviewed 1
• Patients should be encouraged to report any physical or emotional changes experienced while taking glaucoma medications 1
• Ongoing education should include updates on disease status and reinforcement of proper medication techniques 1

Common Pitfalls to Avoid

• Assuming patients understand their condition - many patients with glaucoma have poor follow-up because they perceive their disease as "not serious enough" 1
• Failing to address medication administration challenges - even experienced patients may struggle with proper drop instillation 1
• Overlooking cost concerns - financial barriers significantly impact adherence 1
• Not involving caregivers - many patients depend on companions to assist with drop administration 1

By implementing comprehensive patient education strategies focused on disease understanding, proper medication use, and addressing quality of life concerns, clinicians can improve adherence and outcomes in open angle glaucoma management.