This National Glaucoma Awareness Month, Pharmacists Can Have an Unparalleled Impact on Prevention, Treatment of Glaucoma

January is National Glaucoma Awareness Month, which provides an opportunity for pharmacists to spread information about the disease, as well as its prevention and treatment. Glaucoma is often referred to as the “sneak thief of sight” since it has no early symptoms and is the leading cause of blindness in the United States.¹ Over 3 million people in the United States have glaucoma and the National Eye Institute projects this number will reach 4.2 million by the year 2030.²

However, existing gaps in glaucoma awareness can be overcome through pharmacist participation in public health promotion.³ Although the pharmacist’s role in providing education to patients with glaucoma may be undervalued, they can be a leading source of information about eye disease for patients.³

It is crucial that pharmacists address barriers to care for patients with glaucoma, as pharmacists may be one of the most frequently visited health care providers for these patients. Common barriers experienced by patients with glaucoma include low self-efficacy, difficulty with drop administration, impaired vision, adverse effects, and medication costs.^4,5 Additionally, there is evidence that suggests that there are opportunities for pharmacists to collaborate with patients and health care providers to overcome these challenges.

Patients with glaucoma may not always receive instructions from providers on eye drop administration, which introduces an opportunity for pharmacists to complement care.⁶ Low self-efficacy and difficulty with eye drop administration seem to suggest that patients require additional administration counseling. However, one-third of patients who reported knowing how to administer an eye drop still miss their eye, instill too many drops, or touch the dropper bottle to the surface of the eye.⁷

A drop-aid, that acts as a collar around small eye drop bottles transforming it into a larger and easier to use device, could be used to mitigate these issues. The drop-aid has improved eye drop delivery from a baseline of 66% to 86% by reducing contamination and improving accuracy.⁸ Moreover, these devices are inexpensive with out-of-pocket costs as low as $8. For those patients who do require additional administration counseling if the time available in patient consultations is limited, pharmacists can provide a link to a videotaped recording of how to correctly administer eye drops.⁶

Being conscientious that patients with glaucoma may suffer from impaired vision introduces considerations for medication packaging as well. Novel solutions for the visually impaired include phone applications that read prescription labels, pill bottles that are shaped differently to allow more space for prescription labels, and devices attached to prescription bottles that allow the pharmacist to record directions.9 Patients have also reported that applying black tape to the tip of eye drop bottles made administration easier.10In this way, both novel devices and practical solutions for commonly occurring problems for patients with glaucoma are areas where pharmacist led contributions to care for patients can add significant support.

Additionally, adverse effects experienced by patients can lead to decreased adherence and disease progression. For instance, miotic glaucoma medications (eg, pilocarpine)constrict the pupils and contribute to light sensitivity.11 For this reason, it is critical that patients select appropriate eyewear to minimize adverse effects. Sunglasses should provide 99 to 100% blockage of UV rays, as well as wraparound to prevent UV from entering through the sides.¹²

Furthermore, certain eye drop formulations contain preservatives that cause allergic-type reactions. Currently there are only 3 glaucoma medications available in the United States without preservatives, which include tafluprost (Zioptan; Merck), dorzolamide hydrochloride-timolol maleate (Cosopt; Merck), and timolol.13 Some prescribers may not be as familiar with these non-active ingredients, making pharmacists perfectly positioned to help identify ophthalmic medications that will not only benefit patients’ glaucoma, but will be tolerable as well.

The pharmacist’s role is also not only limited to ophthalmic preparations. Antihypertensives, when taken in the evening, can lower patients’ nocturnal blood pressure, which can exacerbate glaucoma progression.¹⁴ Another opportunity for pharmacists to make an impact is through recommending changes to administration of antihypertensives to the patient and doctor.

Similarly, it is important to make patients aware of drug-disease interactions with glaucoma. Closed-angle glaucoma can be exacerbated by medications used to treat other conditions, including asthma or chronic obstructive pulmonary disease (eg, ipratropium), overactive bladder (eg, anticholinergics), depression (eg, SSRIs, imipramine, venlafaxine, and topiramate), and antihistamines.¹⁵ Conversely, elevated eye pressures in open-angle glaucoma can result from steroids, ophthalmic anticholinergics, and succinylcholine.¹⁵ In order to integrate this information into daily practice, community pharmacists may elect to create a designated area for glaucoma-approved over-the-counter products.

Pharmacists can address cost barriers by identifying medications that are covered by insurance plans or recommend alternative substitutions. For instance, if a combination ophthalmic suspension is denied by a patient’s insurance, then defaulting to generic components of the medication is a practical option. Additionally, connecting patients to programs that discount medications (eg, patient assistance program and manufacturer coupons) is another way pharmacists can help reduce the financial burden for patients.¹⁶

Furthermore, using ophthalmic medications incorrectly can increase cost for patients as they may waste drops or forget to shake suspensions, decreasing the medication’s efficacy. Pharmacists can ensure that patients receive the full benefit of their medications through providing guidance on the proper administration technique.

January is a month in which pharmacists can focus on promoting their role in both the treatment and prevention of glaucoma. Pharmacists serve a distinct role in providing pharmacological, as well as non-pharmacological, services to those affected by glaucoma. Whether it is as simple as stocking sunglasses or as complex as performing medication reviews, the impact pharmacists can have on the treatment and care for patients with glaucoma is of unparalleled value.

REFERENCES

1. January is Glaucoma Awareness Month. Glaucoma Research Foundation. https://www.glaucoma.org/news/glaucoma-awareness-month.php. Accessed December 5, 2021.
2. Glaucoma data and statistics. National Eye Institute. https://www.nei.nih.gov/learn-about-eye-health/outreach-campaigns-and-resources/eye-health-data-and-statistics/glaucoma-data-and-statistics. Published July 17, 2019. Accessed December 5, 2021.
3. Alshammari F, Shaikh S, Hussain A, Alafnan A, Almuzaini I, Alshammari B. Public Awareness of Common Eye Diseases and the Role of Pharmacists in Raising This Awareness in Saudi Arabia: A Cross-Sectional Study. Healthcare (Basel). 2021;9(6):692. Published 2021 Jun 8. doi:10.3390/healthcare9060692)
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9. Products and devices to help you identify your medications. VisionAware. https://visionaware.org/for-seniors/health-and-aging/managing-your-medication/products-and-devices-to-help-you-identify-your-medications/. Published April 23, 2021. Accessed December 13, 2021.
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11. Emanuel M. Light sensitivity and glare with glaucoma. Glaucoma Associates of Texas. https://www.glaucomaassociates.com/glaucoma/light-sensitivity-glare-glaucoma/. Published November 13, 2017. Accessed December 5, 2021.
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13. Yadgarov A. Preservative-free alternatives. Glaucoma Today. https://glaucomatoday.com/articles/2016-nov-dec/preservative-free-alternatives. Accessed December 5, 2021.
14. Melton R, Thomas R. Ophthalmic Drug Guide. Review of Optometry. https://www.reviewofoptometry.com/publications/ro0516-ophthalmic-drug-guide. Accessed December 5, 2021.
15. Ah-Kee EY, Egong E, Shafi A, Lim LT, Yim JL. A review of drug-induced acute angle closure glaucoma for non-ophthalmologists. Qatar Med J. 2015;2015(1):6. Published 2015 May 10. doi:10.5339/qmj.2015.6
16. Financial assistance. Glaucoma Research Foundation. https://www.glaucoma.org/treatment/financial-assistance-and-social-services.php. Published November 30, 2021. Accessed December 5, 2021.