Patterns and Predictors of Repeated Medication Nonadherence in Glaucoma: A Population-Based Study
6 affiliations
- 1FOKUS AUGE Ophthalmology Clinic, 83022 Rosenheim, Germany
- 2Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190500, Israel
- 3Department of Ophthalmology, Rabin Medical Center–Beilinson Hospital, Petach Tikva 4941492, Israel
- 4Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
- 5Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- 6Laboratory of Eye Research, Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel
Abstract
Background/Objectives: We aimed to evaluate nonadherence to topical glaucoma therapy and identify risk factors for repeated prescription fulfillment failure in a large national population-based cohort. Methods: The electronic medical records from a large health maintenance organization were retrospectively reviewed for all patients aged 18 years or older with a diagnosis of glaucoma from 2000 to 2023. Data on patients who had purchased at least one anti-glaucoma medication were retrieved. Compliance was defined as prescription fulfillment within predefined expiration windows of 1, 2, and 3 months. Repeated nonadherence was defined as three unfulfilled prescriptions within a 3-month expiration window. Multivariable Cox proportional hazards models were used to identify risk factors for repeated failure. Results: Among 40,200 treated patients, ≥80% cumulative prescription fulfillment was achieved in 80.3% of the population under a 3-month expiration definition. Under a strict 1-month definition, the incidence rate of the third compliance failure was 335 per 1000 person-years. In multivariable Cox analysis, obesity (HR 1.37, 95% CI 1.29–1.45) and current smoking (HR 1.07, 95% CI 1.04–1.11) were independently associated with increased risk of repeated failure. Older age (≥70 years: HR 0.73, 95% CI 0.62–0.87) and higher baseline intraocular pressure (≥25 mmHg: HR 0.65, 95% CI 0.61–0.68) were associated with reduced risk. Initiation with prostaglandin analogs was associated with lower hazard compared with alpha-2 adrenergic agonists (HR 0.53, 95% CI 0.49–0.57), whereas treatment alterations (≥3 changes) were associated with increased hazard (HR 1.64, 95% CI 1.39–1.95). Conclusions: Repeated nonadherence to topical glaucoma therapy is common and is associated with identifiable behavioral and treatment-related factors. Recognition of patients at elevated risk may support targeted strategies to enhance long-term treatment stability.
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BibTeX
@article{sela2026patterns,
title = {{Patterns and Predictors of Repeated Medication Nonadherence in Glaucoma: A Population-Based Study}},
author = {Tal Corina Sela and Yuval Kozlov and Noa Geffen and Amit Meshi and Guy Melamed and Amir Sternfeld and Yael Sharon and Alon Zahavi},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208038},
url = {https://www.mdpi.com/2077-0383/15/20/8038},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Patterns and Predictors of Repeated Medication Nonadherence in Glaucoma: A Population-Based Study
AU - Tal Corina Sela
AU - Yuval Kozlov
AU - Noa Geffen
AU - Amit Meshi
AU - Guy Melamed
AU - Amir Sternfeld
AU - Yael Sharon
AU - Alon Zahavi
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208038
UR - https://www.mdpi.com/2077-0383/15/20/8038
AB - Background/Objectives: We aimed to evaluate nonadherence to topical glaucoma therapy and identify risk factors for repeated prescription fulfillment failure in a large national population-based cohort. Methods: The electronic medical records from a large health maintenance organization were retrospectively reviewed for all patients aged 18 years or older with a diagnosis of glaucoma from 2000 to 2023. Data on patients who had purchased at least one anti-glaucoma medication were retrieved. Compliance was defined as prescription fulfillment within predefined expiration windows of 1, 2, and 3 months. Repeated nonadherence was defined as three unfulfilled prescriptions within a 3-month expiration window. Multivariable Cox proportional hazards models were used to identify risk factors for repeated failure. Results: Among 40,200 treated patients, ≥80% cumulative prescription fulfillment was achieved in 80.3% of the population under a 3-month expiration definition. Under a strict 1-month definition, the incidence rate of the third compliance failure was 335 per 1000 person-years. In multivariable Cox analysis, obesity (HR 1.37, 95% CI 1.29–1.45) and current smoking (HR 1.07, 95% CI 1.04–1.11) were independently associated with increased risk of repeated failure. Older age (≥70 years: HR 0.73, 95% CI 0.62–0.87) and higher baseline intraocular pressure (≥25 mmHg: HR 0.65, 95% CI 0.61–0.68) were associated with reduced risk. Initiation with prostaglandin analogs was associated with lower hazard compared with alpha-2 adrenergic agonists (HR 0.53, 95% CI 0.49–0.57), whereas treatment alterations (≥3 changes) were associated with increased hazard (HR 1.64, 95% CI 1.39–1.95). Conclusions: Repeated nonadherence to topical glaucoma therapy is common and is associated with identifiable behavioral and treatment-related factors. Recognition of patients at elevated risk may support targeted strategies to enhance long-term treatment stability.
SN - 2077-0383
ER -