Lower resilience tied to poorer medication adherence in glaucoma patients

The COVID-19 pandemic has worsened the adherence to ocular hypotensive medication among patients with primary open-angle glaucoma (POAG), according to a study. Such reduction is potentially driven by lower psychometric measures of resilience and more confrontational coping strategies.

“This may translate into ocular complications and poorer visual outcomes in the months and years after the pandemic,” the researchers said.

A controlled interrupted time series design was implemented in this cohort study, wherein the interruption was the declaration of the COVID-19 pandemic in the US on 13 March 2020. Patients with POAG enrolled in the National Institutes of Health-funded study were included if they received ocular hypotensive medication and had available adherence data.

Using a “slope change following a lag,” the researchers applied segmented regression analysis to determine the adherence slopes in the periods before and after the segmentation. They then compared the two slopes using the Davies test.

Overall, 79 patients (mean age 71 years) participated in this study. Segmented regression established a breakpoint at day 28 following the pandemic declaration. The slope in the period after the breakpoint (‒0.04 percent/day) differed significantly from zero (p<0.001) and from the slope in the period prior to the breakpoint (0.006 percent/day; p<0.001). [Ophthalmology 2022;129:258-266]

Mean adherence in the period before the segmentation breakpoint was significantly worse among Black patients (median, interquartile range [IQR]: 80.6 percent, 36.2 percent) than their White counterparts (median, IQR: 97.2 percent, 8.7 percent; chi-square, 15.4; p=0.0004).

In addition, the Connor-Davidson resilience score positively correlated with the change in slope between the periods before and after the breakpoint (p=0.002), indicating that lower resilience and having a more threatening view of glaucoma could lead to poorer adherence.

“Given that ocular hypotensive medications are the first line of treatment for POAG, many patients are likely to have experienced a reduction in medication coverage during the pandemic,” the researchers said. “The long-term implications are concerning because poor adherence has been associated with visual field progression.” [Ophthalmology 2020;127:477-483]

Previous studies reported the association between resilience, defined as the process of positive adaptation to adversity, and medication adherence in some chronic diseases, except glaucoma. [Lupus 2021;30:1051-1057; AIDS Patient Care STDS 2014;28:136-143; Psychol Health Med 2017;22:570-577]

The positive association seen in the current study between resilience and medication adherence in the period before the pandemic delivers evidence for a protective role of resilience against nonadherence to ocular hypotensive medication, according to the researchers.

Consequently, “[t]he pandemic offered an opportunity to assess whether higher resilience would allow patients to maintain the baseline level of adherence in the face of the adversity imposed by the pandemic,” they added.

On the other hand, confrontive coping, defined as taking aggressive efforts to change a situation, showed a negative association with change in adherence slope. In a pandemic, such behaviour could diminish an individual’s ability to focus on the medication regimen, the researchers said.