The Association between a Pharmacy-Based Estimate of Medication Adherence and Surgical and Laser Treatments in Patients with Glaucoma

IF 3.3 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma Pub Date : 2026-09-01 Epub Date: 2026-03-02 DOI:10.1016/j.ogla.2026.02.005

Kenneth C. Peng BA, Louay Almidani MD, MSc, Chris Bradley PhD, Jithin Yohannan MD, MPH

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Abstract

Purpose

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

Design

A retrospective cohort study.

Subjects

A total of 4480 medically treated glaucoma and glaucoma suspect eyes from 3668 patients who presented to the Wilmer Eye Institute between November 2015 and March 2025, with at least 1 visual field (VF), 1 OCT scan, 1 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 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 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 nonmedical interventions.

Results

The average medication adherence measured by PDC was 56.1% (standard deviation: 23.6). Of the 4480 eyes studied, 1724 (38.5%) eyes received medical treatment exclusively, while 2756 (61.5%) underwent at least 1 procedure. Among those that had a procedure, 1396 (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 (hazard ratio [HR]: 1.05, 95% confidence interval [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 nonmedical intervention. In eyes with severe baseline disease, lower PDC correlated with a higher likelihood of traditional glaucoma surgery but not laser or MIGS procedures.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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青光眼患者的药物依从性与手术和激光治疗之间的相关性。

目的：了解青光眼和疑似青光眼患者的药物依从性，并探讨其与传统手术、微创青光眼手术（MIGS）和激光治疗等非药物治疗的关系。设计：回顾性队列研究。研究对象：2015年11月至2025年3月期间，在Wilmer眼科研究所就诊的3,668名患者中，共有4,480只接受过药物治疗的青光眼和疑似青光眼，至少有一次视野（VF），一次光学相干断层扫描（OCT），一次诊所就诊，以及相应的局部眼压降低药物的药房声明数据。方法：根据现行程序术语（CPT）编码，按干预类型对患者手术进行分类。确定第一次VF、OCT或门诊就诊与第一次激光或外科手术之间的时间。使用覆盖天数比例（PDC）估计药物依从性，使用电子医疗记录（emr）和药房索赔数据中的处方和配药数据计算药物依从性。多变量Cox回归评估了PDC与传统手术、激光治疗或MIGS可能性之间的关系。对基线青光眼严重程度进行亚组分析。主要结果测量：初始非医疗干预的类型和时间。结果：PDC平均依从性为56.1% （SD: 23.6）。在研究的4,480只眼睛中，1,724只（38.5%）只接受了医学治疗，而2,756只（61.5%）至少接受了一次手术。在接受手术的患者中，1396例（31.2%）接受了激光治疗，507例（11.3%）接受了MIGS治疗，853例（19.0%）接受了传统手术。低10%的PDC与激光治疗（HR: 1.05, 95% CI: 1.02-1.07）、MIGS （HR: 1.07, 95% CI: 1.03-1.11）和传统手术（HR: 1.15, 95% CI: 1.11-1.18）的可能性增加相关。在可疑和轻度基线青光眼中，较低的PDC与激光治疗（HR: 1.12, 1.04）、MIGS （HR: 1.16, 1.07）和传统手术（HR: 1.14, 1.22）相关。在中度和重度基线青光眼中，较低的PDC仅与传统手术相关（HR: 1.12, 1.09）。结论：低PDC与接受任何非医疗干预的可能性增加有关。在患有严重基线疾病的眼睛中，较低的PDC与传统青光眼手术的可能性较高相关，而与激光或MIGS手术无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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