All ETDs from UAB

Advisory Committee Chair

Lyne Racette

Advisory Committee Members

Matthew M Fifolt

Yu-Mei Schoenberger-Godwin

Lawrence C Sincich

Michael D Twa

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Optometry


Over 60 million persons globally are affected by primary open angle glaucoma (POAG)—an optic neuropathy characterized by distinctive patterns of vision loss. Glaucoma is a leading cause of irreversible blindness worldwide, and eye drops that delay vision loss are a common treatment modality. In glaucoma, the proportion of patients with good adherence to recommended therapy is reported to be low. High treatment cost, forgetfulness, and regimen complexity have been identified as key determinants of poor adherence. However, addressing these factors in the clinic is not as simple, as patient and provider values and priorities may differ. Without concordance, it can be difficult to achieve optimal management of glaucoma. In Aim 1, shared values related to glaucoma treatment were identified among patients and providers. Perceived treatment efficacy, glaucoma knowledge, good quality of life, and good patient-provider relationship were recognized by both groups as critical in maintaining good adherence. Interventions may also target these factors and leverage them in order to improve adherence. However, tailoring of interventions is needed so that they adequately meet the needs of patients who are clinically distinct from each other. In Aim 2, this diversity was quantified by identifying distinct patterns of long-term adherence. Statistical modeling was used to identify four patterns: Near-perfect, Good, Declining, and Poor. Characterizing these iv groups could reveal other shared attributes which can be used to improve tailoring of existing interventions and increase their effectiveness. Tailoring can be a challenge however, as there is a dearth of compelling evidence for the recommendation of any specific interventions. This has been attributed to heterogeneity in intervention design, non-reliance on health theory, and diverse patient needs. Employing an evidence-based approach that incorporates theoretical evidence, patient experience, and provider expertise, a taxonomy of evidence-based strategies for improving medication adherence was developed in Aim 3. Education, reminders, health coaching, and motivational interviewing were identified as being most effective and having the highest utility in maintaining good adherence. A thorough understanding of the factors that impact adherence can guide the development of well-designed interventions that appropriately target these deterministic factors and prevent vision loss.

Included in

Optometry Commons



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