title: Measurement of adherence to brimonidine therapy for glaucoma using electronic monitoring.
abstract: OBJECTIVE
  To assess the patient adherence and behavior with brimonidine twice daily (bid) or 3 times daily (tid) in patients used to topical glaucoma medication.
  
  
  METHODS
  Seventy-five patients with glaucoma or ocular hypertension were enrolled in a prospective, observational cohort study. Consenting patients were randomly assigned to brimonidine bid or tid and received conventional brimonidine eye drops with attached electronic monitoring devices for 4 weeks. Patients were not explicitly informed on the compliance monitoring.
  
  
  RESULTS
  The study was completed by 67 patients (89%). In 65 patients (97%), at least 1 dosing interval exceeded 24 hours. The mean adherence rates were better in the brimonidine bid group (72 ± 19% vs. 62 ± 16%, P=0.04), although dosing frequency was higher in the tid group (1.9 ± 0.5 vs. 1.4 ± 0.4 per day; P<0.001). On average medication coverage was 70% for the bid group and 67% for the tid group; 19 patients (28%) had a coverage rate above 75%, 42 patients (63%) 50% to 75%, and 6 (9%) below 50%. Patients with normal-tension glaucoma had lower coverage rates than patients with primary open-angle glaucoma and ocular hypertension (P<0.05). Data also showed that on average 20% of the glaucoma medication was wasted owing to inefficient drug delivery by using more than 1 drop per dosing.
  
  
  CONCLUSIONS
  Individual adherence with brimonidine was highly variable and pharmacologically insufficient for more than two-third of the patients. Special attention should be paid to compliance of patients with normal-tension glaucoma. Our findings underline the need to improve individual adherence and drug delivery in topical glaucoma therapy.
authors.affiliation: Department of Ophthalmology, University Hospital, Cologne, Germany. manuelhermann@uk-koeln.de
authors.forename: Manuel Marcel
authors.initials: MM
authors.lastname: Hermann
authors.forename: Alain Marie
authors.initials: AM
authors.lastname: Bron
authors.forename: Catherine P
authors.initials: CP
authors.lastname: Creuzot-Garcher
authors.forename: Michael
authors.initials: M
authors.lastname: Diestelhorst
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D000068438:Brimonidine Tartrate; D016903:Drug Monitoring / Q000295:instrumentation*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy*; D015438:Health Behavior; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D057066:Low Tension Glaucoma / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011446:Prospective Studies; D011810:Quinoxalines / Q000008:administration & dosage*; D014065:Tonometry, Ocular
chemical_list: D000959:Antihypertensive Agents; D009883:Ophthalmic Solutions; D011810:Quinoxalines; D000068438:Brimonidine Tartrate