5 Common Reasons Glaucoma Patients Don't Use Eyedrops as Recommended by Their Doctor

If you've ever taken any medication for more than a few weeks, you know how difficult it can be to stick to a strict drug regimen, particularly if you're taking several different medications, each with its own specific set of instructions. If you have glaucoma, following the prescribed regimen may be an even greater challenge.

Not only might you need to use eyedrops multiple times each day, but you also need to get them into your eye - a more complicated task than swallowing a pill. And you may not remember if you've missed a dose. If you forget to take a few pills, you'll have some left over at the end of the month to indicate that you didn't dose perfectly. With eyedrop bottles, on the other hand, you can't look at the bottle and see that doses were missed.

But not following your treatment regimen can lead to irreversible vision damage that can make blindness more likely than it needs to be. Fortunately, taking some simple steps can help you get back on track with your medication regimen: The first step is to be honest with your doctor.

A Common Challenge

According to the Glaucoma Adherence and Persistency Study, people with glaucoma take, on average, only 64 percent of their prescribed eyedrop doses, and an even fewer - 10 percent - take their medication continuously for one year without any breaks. Yet, 95 percent of patients tell their doctor they never miss taking their eyedrops.

If you see yourself in these statistics, don't be afraid to admit to your doctor that you've fallen short. Misrepresenting your medication-taking habits harms only you. For example, if you don't stick to the regimen and your condition deteriorates, your doctor may prescribe a higher dosage, a different drug, or multiple drugs that could produce more side effects or be more expensive. Or you might need to undergo a surgical procedure that could have been avoided by following the doctor's treatment plan. Or worse, you could lose your sight.

So have an open and honest discussion with your doctor about your medication use. Your doctor can help you identify the reasons for your lack of adherence and suggest strategies to overcome them. Below are five common reasons that people get off track and some suggestions on how to get back on.

Reason 1. Forgetfulness Forgetfulness is one of the most common reasons people don't stick to their regimen, particularly if they're taking more than one medication. It's particularly easy to miss a dose if your daily routine changes, for example, on the weekend or when traveling on vacation or business. And forgetfulness is the reason patients sometimes overstate how well they're doing. They really think they're doing better than they are because they forget that they've forgotten to use their eyedrops.

Fortunately, technology can be your ally in the war against forgetfulness, although nontech solutions abound as well.

Electronic reminders. If you own a smartphone or wish to buy an inexpensive jogger's wristwatch, set the alarm to go off at the prescheduled time(s) for your drops. Another alternative is a reminder service. Some companies will text, call, or email you reminder messages for a fee. Other companies offer these services at no cost. But be sure to read the privacy policy before signing up. Many sites that offer free services collect and sell your personal information in lieu of a fee.

Low-tech help. A simple way to remember to use your glaucoma medication is to incorporate it into your daily routine. For example, if you're on a four-times-a-day schedule, use your eyedrops in the morning after brushing your teeth, at lunchtime, at dinner, and before going to bed. Another strategy is to post reminders where you’ll be sure to see them such as on your bathroom mirror.

To verify that you've been taking your eyedrops, keep a simple paper calendar and pencil next to them. Mark each dose taken with a check, and at the end of the week, see how many checks are missing.

The human touch. If you live with a spouse, partner, relative, or caregiver, have them remind you to take your medication.

Communication with your doctor. Tell your doctor what problems you are having with your eyedrops. He or she may be able to adjust your prescriptions so that you take fewer doses or fewer medications. For example, you may be able to switch to once-a-day drops or to a combination product that contains two types of drops in one bottle. Or there may be a lower cost or more convenient bottle size to help.

Reason 2. The Drops Won't Go In A 2009 study in the Archives of Ophthalmology found that more than 20 percent of glaucoma eyedrop users failed to get one drop at a time in their eye—often wasting several drops or even missing the eye entirely. If you've followed the instructions that come with your eyedrops but are still having trouble, try this trick. First, lie down or sit in a big comfortable chair with your head all the way back so that your face is horizontal. Hold the eyedrop bottle upright over the side of your eye closest to your nose. Once you're in that position, then turn the bottle over so a drop will come out. You only need to get a part of the drop on the eye for it to work. So as long as the drop hits anywhere near the inside corner, enough will get onto your eye, even if your eye is almost closed when it first hits. Using several drops to "be sure" is not a good approach. It wastes drops and you will run out before the month is over—many pharmacy plans only provide enough medicine for one drop per delivery.

Are shaky hands the problem? Try resting your palm on your cheek or forehead as you apply the drops or steady one hand with the other one. Some companies sell eyedrop aids, which may also be of help for some people.

Reason 3. Side Effects Occasionally, glaucoma drugs cause side effects that can discourage you from using the medication. Some side effects are minor, but others can be more serious. Beta-blocker eyedrops, for example, may affect your heart rate, blood pressure, or ability to breathe.

Administering your eyedrops correctly can minimize the risk of side effects by increasing the amount of medication that is absorbed directly into your eye, rather than into your bloodstream. Here's the recommended technique: After the drop gets in your eye, close your eyelid and gently press the inside corner of your eyelid at your tear duct for at least one minute.

Reason 4. No Symptoms Research shows that the people who have long-term diseases with no symptoms are less likely to take medicines as prescribed. This is understandable because it doesn't seem that the medicine is "helping" if there are no visible signs of improvement. With glaucoma, the patient can't tell that the eye pressure is lower or that the risk of vision loss is lower. But it's important to remember that even though you may not notice any symptoms, your eye pressure must be kept at the target level. To control the pressure and help prevent permanent, serious eye damage and vision loss, you'll need to use your eyedrops as prescribed.

Reason 5. Cost Concerns Talk to your doctor if cost is a concern. Some glaucoma medications are available for less than $10 per month even without a special drug benefit. In some cases, a less expensive, generic version may be available. In addition, a number of manufacturers of glaucoma drugs and government programs offer free or discounted medication to certain low-income individuals without prescription drug coverage.

To find out whether you qualify and whether an assistance program is available for your medication, visit www.pparx.org and www.rxassist.org. Your doctor's office or the pharmacist also can help you find out more about these programs.

Getting Back on Track

People get off track with their medication regimen for many reasons, but fortunately there are just as many possible solutions. If any of the above-mentioned reasons for nonadherence apply to you, try the accompanying suggestions to get back on your medication regimen—and stay on it—before your next appointment with the eye doctor. If your get-back-on-track strategy involves input from your doctor, don't hesitate to reschedule your appointment for an earlier date.

Publication Review By: Susan B. Bressler, M.D., Harry A. Quigley, M.D., Oliver D. Schein, M.D., M.P.H.

Published: 25 Feb 2011

Last Modified: 07 Jan 2015