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    Drug delivery systems could improve poor adherence


    Studies confirm non-adherence

    Studies have shown that most patients do not completely adhere to the regimens for their glaucoma prescriptions. In one study (Ophthalmology, 2009 Feb; 116(2):191-9), almost 45% of patients used their drops less than 75% of the time, even though they got free medication and knew that their adherence was monitored electronically.

    Patients reported that they were taking a lot more medication than the monitoring indicated. And, their physicians had no idea how much their patients were taking.

    "This shows the challenge," Dr. Myers told Ophthalmology Times. "We'd all agree it would be preferable if drug administration could be done for the patient."

    Since the depots must be implanted and/or refilled via injection, the question rises whether they pose a risk of endophthalmitis.

    Assuming yearly injections over 20 years and an endophthalmitis vision loss rate similar to that of anti-vascular endothelial growth factor (anti-VEGF) drugs, about 0.15% of patients would lose at least 2 lines of vision from endophthalmitis.  By contrast, the risk of blindness from glaucoma over 20 years is 6.5%.

    "The risk is very much justified versus the risk of going blind," Dr. Myers said. "It's not unreasonable to think about doing these injections."


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