Clinical recommendations for early identification of patients with open‐angle glaucoma at higher risk of low adherence to topical treatment: An Italian Delphi consensus

Purpose: It is important for clinicians to identify patients with glaucoma at higher risk of poor adherence to topical therapy at an early stage to prescribe alternative treatments. An expert-based set of statements was developed to assist clinicians in the early identification of patients at high risk of low adherence and subsequent poorer clinical outcomes. Methods: A two-step strategy was used. First, statements were developed by a panel of experts using data from a literature search as a starting point. Second, we measured agreement with the statements in a representative group of ophthalmologists managing patients affected by glaucoma. Results: A total of 18 statements and consensus was reached for all. The available evidence and clinical experience have identified some subpopulations at high risk of poor adherence. These include young individuals with competing interests, being frequently away from home, multiple comorbidities and particularly when they affect joint function of the hands or cognitive abilities, being asymptomatic, and being poorly informed about the severity of the disease. The unavailability of caregivers and living alone seems to be relevant factors, particularly in older and more frail patients. Conclusion: Taken together our results allow us to profile patients with glaucoma who will be more likely to show poor adherence to topical treatments. Moreover, the consensus statements can be used to identify patients who are unsuitable for topical drops and who would benefit more from alternative treatments.