Anticipated Impact on Veteran's Healthcare: Over 1 million Veterans live with uncorrectable visual impairment that is severe enough to reduce quality of life and independence. We propose to test an intervention designed to improve glaucoma medication adherence with the ultimate goal of reducing glaucoma- related blindness in Veterans. Project Background: Glaucoma is a leading cause of irreversible blindness among Veterans and across the US. The number of Americans with glaucoma is rising due to the aging population, yet there is still no cure for the disease. The only treatment that has been proven to reduce the risk of vision loss from glaucoma is lowering the intraocular pressure. The most common treatment to lower intraocular pressure is the prescription of glaucoma eye drops. Although multiple clinical trials have shown that intraocular pressure can be lowered by the daily use of glaucoma eye drops and glaucoma–related vision loss can be reduced, adherence to the prescribed glaucoma regimen is often poor. Patients with medical comorbidities are at higher risk for glaucoma medication nonadherence, which is worrisome for the visual outcomes of Veterans because, on average, Veterans are more likely to have more numerous medical co-morbidities than their non-Veteran age-matched peers. Project Objectives: There is a critical need for an evidence-based intervention that improves glaucoma medication adherence at reasonable cost and with clinically relevant outcomes. The objective of this application is to conduct a randomized, controlled trial to evaluate a novel intervention designed to improve glaucoma medication adherence in Veterans and ultimately reduce glaucoma-related blindness. We will accomplish this through the following specific aims. Specific Aim 1: Evaluate the impact of a novel intervention to improve glaucoma medication adherence through a randomized controlled trial. Specific Aim 2: Evaluate the impact of the intervention on intensification of glaucoma therapy among Veterans with glaucoma. Specific Aim 3: Evaluate the incremental cost-effectiveness and budget and workflow impacts of the intervention compared to control. Project Methods: We propose to randomize 200 Veterans with medically-treated glaucoma and up to 200 companions to 1 of 2 arms, providing 80% power to detect a 10% difference in the proportion of prescribed glaucoma medication doses taken between the 2 arms in the 6 months following the intervention as measured by electronic monitors. The intervention is multifaceted but simple in design in order to facilitate implementation in a busy clinical setting. An ophthalmic technician will provide clear education about glaucoma, addresses specific barriers to adherence identified by the Veteran in a validated survey of glaucoma medication self-efficacy, and will coach patients on eye drop administration techniques, and recommend eye drop aids if functional limitations are identified. The technician will provide an individualized glaucoma medication reminder schedule. The Veteran will be given a novel medication container in which to store the glaucoma bottle that records the time and date that the medication is accessed and alerts the Veteran via text or voicemail if the medication has not been accessed within the specified time frame. In summary, the study outlined in this proposal has the potential to reduce glaucoma-related blindness in Veterans and may lead to strategies to improve self-management in other chronic eye diseases.

Glaucoma is a leading cause of blindness among Veterans. Lowering the intraocular pressure with glaucoma eye drops reduces the risk of vision loss from glaucoma, but glaucoma eye drops are frequently not taken as prescribed. Therefore, there is a need to implement interventions that improve glaucoma medication adherence and reduce glaucoma-related blindness. This study will examine a multifaceted intervention that includes glaucoma education, personalized suggestions to address barriers to adherence, aids for drop administration when needed, involvement of companions, and a novel drop reminder system that alerts Veterans to missed doses.