The association between a pharmacy-based estimate of medication adherence and surgical and laser treatment in glaucoma patients.

PURPOSE

To investigate medication adherence in glaucoma and glaucoma suspect patients and explore its relationship with non-pharmacological treatments, including traditional surgery, minimally invasive glaucoma surgery (MIGS), and laser treatment.

DESIGN

Retrospective cohort study. SubjectsA total of 4,480 medically treated glaucoma and glaucoma suspect eyes from 3,668 patients who presented to the Wilmer Eye Institute between November 2015 and March 2025, with at least one visual field (VF), one optical coherence tomography (OCT) scan, one clinic visit, and corresponding pharmacy claims data for topical intraocular pressure-lowering medications.

METHODS

Patient procedures were categorized by intervention type based on Current Procedural Terminology (CPT) codes. Time between the first VF, OCT, or clinic visit and the first laser or surgical procedure was determined. Medication adherence was estimated using the proportion of days covered (PDC), calculated using prescription and dispensing data from electronic medical records (EMRs) and pharmacy claims data. Multivariable Cox regressions assessed the association between PDC and the likelihood of traditional surgery, laser treatment, or MIGS. Subgroup analysis of baseline glaucoma severity was also conducted.

MAIN OUTCOME MEASURES

Type and timing of initial non-medical interventions.

RESULTS

The average medication adherence measured by PDC was 56.1% (SD: 23.6). Of the 4,480 eyes studied, 1,724 (38.5%) eyes received medical treatment exclusively, while 2,756 (61.5%) underwent at least one procedure. Among those that had a procedure, 1,396 (31.2%) underwent laser treatment, 507 (11.3%) underwent MIGS, and 853 (19.0%) underwent traditional surgery. A 10% lower PDC was associated with an increased likelihood of laser treatment (HR: 1.05, 95%

CI

1.02-1.07), MIGS (HR: 1.07, 95%

CI

1.03-1.11), and traditional surgery (HR: 1.15, 95%

CI

1.11-1.18). In suspect and mild baseline glaucoma eyes, lower PDC was associated with laser treatment (HR: 1.12, 1.04), MIGS (HR: 1.16, 1.07), and traditional surgery (HR: 1.14, 1.22). In moderate and severe baseline glaucoma eyes, lower PDC was associated with traditional surgery only (HR: 1.12, 1.09).

CONCLUSIONS

Lower PDC was associated with an increased likelihood of undergoing any non-medical intervention. In eyes with severe baseline disease, lower PDC correlated with a higher likelihood of traditional glaucoma surgery but not laser or MIGS procedures.