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Santos-Bueso, F. Sáenz-Francés, S. García-Sáenz, C.D. Méndez-Hernández, A.M. Fernández-Vidal, L. Morales-Fernández, C. Martín-Valdizán, J.M. Martínez-de-la-Casa, J. García-Feijoo, J. García-Sánchez" "autores" => array:10 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Santos-Bueso" "email" => array:1 [ 0 => "esbueso@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Sáenz-Francés" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "García-Sáenz" ] 3 => array:2 [ "nombre" => "C.D." "apellidos" => "Méndez-Hernández" ] 4 => array:2 [ "nombre" => "A.M." "apellidos" => "Fernández-Vidal" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "Morales-Fernández" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Martín-Valdizán" ] 7 => array:2 [ "nombre" => "J.M." "apellidos" => "Martínez-de-la-Casa" ] 8 => array:2 [ "nombre" => "J." "apellidos" => "García-Feijoo" ] 9 => array:2 [ "nombre" => "J." "apellidos" => "García-Sánchez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Glaucoma y Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cumplimiento del tratamiento del glaucoma" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">One of the big problems that we ophthalmologists encounter when treating glaucoma, despite new advances in medical and surgical treatments, is the failure of patients to comply with prescribed treatments. Treatment compliance encompasses adhesion (degree of correctness or accuracy with which patients carry out treatment) and persistence (duration in time where patients maintain treatment<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>).</p><p id="par0010" class="elsevierStylePara elsevierViewall">Many factors influence treatment noncompliance, and this may be intentional (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) or unintentional (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Intentional failure to comply with treatment by patients is due to several factors, such as lack of awareness of the seriousness of the process, side effects from topical agents or inability to comply due to osteoarticular or related neurological disease (which preclude application resulting from container hardness or related tremor) or social or financial factors. However, unintentional failure to comply is due to neurological disease (cognitive impairment), multiple treatments that lead to confusion and even low visual acuity in patients, which prevents them from correctly identifying their medicines.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> The attitude of the ophthalmologist must seek to resolve those factors influencing intentional and unintentional failure to comply (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In an unpublished study conducted on glaucoma treatment compliance, 75 patients were divided into three groups: patients who lived alone, couples living by themselves, and couples who lived with their children. Results were as follows: 40% of patients living alone, 15% of patient couples living together, and 5% of patient couples living with their children failed to comply with treatment. 12%, 17.5% and 2.5% (respectively) failed to remember or recognize treatment, when they were shown all current available commercial presentations.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In summary, from the Glaucoma and Neuro-Ophthalmology Unit of the San Carlos Clinic Hospital in Madrid, we want to emphasize the vital importance of making our patients aware of the need for compliance, emphasizing the severity of the glaucomatous process and risk of blindness. We need to recheck, test and reiterate the prescribed treatment, at each patient visit to Glaucoma Units, and adapt treatment to personal, family, social and financial characteristics of each of our patients.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A good doctor-patient relationship based on the ophthalmologist's involvement in the patient's situation and trust in the physician, and adequate and fluent communication with primary care are critical to properly conduct the prescribed glaucoma treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Santos-Bueso E, Sáenz-Francés F, García-Sáenz S, Méndez-Hernández CD, Fernández-Vidal AM, Morales-Fernández L, et al. Cumplimiento del tratamiento del glaucoma. Arch Soc Esp Oftalmol. 2014;89:297–298.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Paper presented at the 89th Congress of the Spanish Society of Ophthalmology (Tenerife, September 25–28, 2013).</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Intentional failure to comply \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Physician's response \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lack of knowledge of severity of glaucomatous disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Explain and emphasize disease and risk of blindness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Drug side effects \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Using more tolerable drugs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complexity of combined treatments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Simplify treatments; use set combinations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Financial factors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prescribe least expensive but effective drugs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Related neurological disease that precludes application (tremor, rigidity, etc.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Simplify and tailor treatment to patient's neurological disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Related osteoarticular disease precluding application (container hardness) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Simplify and tailor treatment to patient's osteoarticular disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Social factors (fear, embarrassment, etc.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Explain and demystify glaucomatous disease \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab565950.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Factors affecting intentional compliance with prescribed glaucoma treatments and physician's response mechanisms.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Unintentional failure to comply \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Physician's response \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low visual acuity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improve visual acuity by graduation or surgery, if possible \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cognitive impairment, forgetfulness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Referral to neurology or geriatrics, even from early stages of deterioration \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Confusion with some commercial forms and their similarity to artificial tears \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adapt and simplify topical treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inability to apply treatment due to social factors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smooth communication with primary care and social services \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inability to apply treatment due to financial factors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smooth communication with primary care and social services \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Related osteoarticular disease precluding implementation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Referral to rheumatology, orthopedics and rehabilitation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple treatments for different diseases and the generated confusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Referral to different specialties and primary care to consolidate treatments \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab565951.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Factors affecting unintentional failure to comply with prescribed glaucoma treatments and physician's response mechanisms.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Importancia de la adherencia al tratamiento en el glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. 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Letter to the Editor
Glaucoma treatment compliance
Cumplimiento del tratamiento del glaucoma
E. Santos-Bueso
, F. Sáenz-Francés, S. García-Sáenz, C.D. Méndez-Hernández, A.M. Fernández-Vidal, L. Morales-Fernández, C. Martín-Valdizán, J.M. Martínez-de-la-Casa, J. García-Feijoo, J. García-Sánchez
Corresponding author
Unidad de Glaucoma y Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain