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Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study
  1. Heather Waterman1,
  2. Simon Read1,
  3. James Edwards Morgan2,
  4. David Gillespie3,
  5. Claire Nollett3,
  6. Davina Allen1,
  7. Marjorie Weiss4,
  8. Pippa Anderson5
  1. 1 School of Healthcare Sciences, Cardiff University, Cardiff, UK
  2. 2 School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
  3. 3 Centre for Trials Research, Cardiff University, Cardiff, South Glamorgan, UK
  4. 4 School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
  5. 5 Swansea Centre for Health Economics, Swansea University College of Human and Health Sciences, Swansea, UK
  1. Correspondence to Dr Simon Read, School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, UK; readsm{at}


Background/aims Assess whether a new clinical pathway for glaucoma was acceptable to patients and healthcare professionals and whether it provided useful clinical information on non-responsiveness and non-adherence to the treatment of elevated intraocular pressure with latanoprost eye drops.

Methods A single arm non-randomised prospective observational study incorporating new glaucoma/ocular hypertension patients. To assess issues of acceptability, qualitative observation and interviews were conducted with patients and healthcare professionals. To determine clinical responsiveness, intraocular pressures were measured before and 4 hours after a clinician-instilled eye drop over two distinct appointments. Adherence data were collected using a Medicine Event Monitoring System. Economic analyses compared the costs between novel and standard care pathways.

Results Of 72 patients approached, 53 entered the study (74.3%) and 50 completed all procedures (94.3%). Intraocular pressure was reduced more than 15% in 83 out of 92 study eyes by final visit (90.2%). The non-response rate was 5.1% once the effect of low adherence was minimised. For the 1376 drop instillation days under observation, eye drops were instilled as prescribed on 1004 days (73.0%), over-instilled on 137 days (9.9%) and not instilled on 235 days (17.1%). The Cardiff Model of Glaucoma Care involved negligible cost, although acceptance for healthcare professionals showed variation.

Conclusions The Cardiff Model of Glaucoma Care offers novel clinical and adherence insights at marginal costs while acceptable to patients. Healthcare professionals felt that 4 hour and 4 week follow-up appointments could cause administrative problems. A streamlined version of the pathway has therefore been developed to facilitate clinical adoption.

Trial registration number ISRCTNID:ISRCTN75888393

  • glaucoma
  • intraocular pressure
  • drugs
  • epidemiology
  • pharmacology

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  • Contributors Heather Waterman is a professor of nursing and ophthalmology with a background in patient self-care for long-term conditions. Simon Read is a sociologist with a research background in ageing, health and well-being. James Morgan is a consultant ophthalmologist and professor in ophthalmology with over 25 years experience. David Gillespie is a senior research fellow and statistician with an interest in adherence data. Claire Nollett is a trials researcher with a background in psychology and chronic conditions. Marjorie Weiss is a professor of pharmacy practice researching decision-making around the taking and prescribing of medicines. Davina Allen is a nurse and medical sociologist focussed on the organisation of work and service improvement. Pippa Anderson is an associate professor of health economics with a particular interest in resource allocation. All authors and contributors were involved in the drafting and review process of the article.

  • Funding This research was funded in full by the Health and Care Research Wales Research for Patient and Public Benefit fund, ref: RfPPB-16a-1296. The funding organisation had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics Committee approval was obtained from West Midlands – Black Country Research Ethics Committee (IRAS Project ID: 232242).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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