Dry Eye Dx and Tx

Enhancing Patient Adherence to Dry Eye Therapy, Part 2

Dry Eye Dx and Tx

Enhancing Patient Adherence to Dry Eye Therapy, Part 2



In Part 1 of this series, we looked at factors that influence patient compliance (adherence) to therapy. Patient adherence to a treatment regimen is crucial to attaining good patient outcomes (American College of Preventive Medicine, 2011). One key factor in obtaining good adherence is the quality of the patient-provider relationship, which is based on the concept that providers prescribe or make recommendations predicated on what is in the best interest of their patients, and that patients adhere to recommended treatment plans for their own welfare. This cooperative effort, often referred to as patient activation (American College of Preventive Medicine, 2011), occurs when “individuals believe they have an important role in their health and health care and have the knowledge, skills, confidence, and emotional commitment to perform this role,” (Alexander et al, 2012).

Ways to Increase Adherence

Alexander et al (2012) examined how patient-provider relationships affect patient activation. They reported that three variables predicted increased patient activation: 1) higher quality interpersonal communication with their providers, 2) fairness and respectful treatment by physicians, and 3) frequent communication by providers apart from office visits.

Physical limitations may play a role in non-adherence. Winfield et al (1990) evaluated 200 patients taking eye drops for various ocular conditions and found that 21 percent always required someone else to instill the drops, while more than half reported difficulty with instilling their own drops. They found that up to 50 percent of patients using eye drops may have severe difficulty in administering them due to physical limitations. These findings suggest that practitioners may need to determine whether patients are physically able to instill prescribed drops.

Treatments that positively impact patient signs and symptoms can indirectly enhance compliance. Trattler et al (2006) evaluated more than 3,000 individuals taking Restasis (cyclosporine A, Allergan); 79 percent of participants stated that they used the drops as prescribed (twice daily). It is significant that increased tear film production and greater patient satisfaction with cyclosporine therapy were associated with higher degrees of compliance.

Patient handouts are an established means of reinforcing in-office instruction and enhancing patient adherence, but the format and wording are crucial. The reading and education levels of patients vary widely. The National Assessment of Adult Literacy (2003) reported that 22 percent of adults possessed “below basic” skills. Muir and Lee (2010) reported that individuals who have reduced health literacy are less likely to demonstrate a good understanding of their disease and are less likely to adhere to treatment regimens. Their study suggests that handouts are most effective when they contain simple, direct language directed at no higher than an eighth grade literacy level.

Carenini et al (1994) reported that impersonal, out-of-context information has minimal impact on patient adherence as compared to relevant, patient-specific information. They suggested that a computer-based system that allows patients to access patient-specific materials with less technical language has more impact on patient adherence compared to conventional handouts. CLS

For references, please visit and click on document #209.

Dr. Townsend practices in Canyon, Texas, and is an adjunct professor at the University of Houston College of Optometry. He is president of the Ocular Surface Society of Optometry and conducts research in ocular surface disease, lens care solutions, and medications. He is also an advisor to Alcon, B+L, CooperVision, Tearlab Corporation, and Vistakon. Contact him at