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Incarcerated Glaucoma Patients Struggle With Adherence

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Levi N. Kanu, MD, and fellow researchers from the University of Illinois posited that glaucoma care for prison inmates is underrepresented in the literature, even though managing the treatment of such patients may provide unique challenges. Their goal was to evaluate the glaucoma profiles of prison inmates treated at an academic ophthalmology center and to report on the medical and surgical management and follow-up metrics. This retrospective cohort study assessed data from 82 incarcerated patients treated at the glaucoma clinic, an academic referral center at the University of Illinois at Chicago, between January 2013 and December 2017. The research was reported in a recent issue of JAMA Ophthalmology. Diagnosis, disease severity, medical and surgical interventions, and patient-reported medication adherence were recorded for each visit. Recommended and actual follow-up times were recorded and compared.

In all, 82 patients (161 eyes) had 375 visits during the study period. All of the patients were male and ranged from 20 to 75 years of age. Most participants were African American (79.3%). The most common diagnoses were primary open-angle glaucoma (POAG, 32.9% and POAG suspect, 32.3%). Glaucoma severity ranged from mild (25 of 77 eyes [32.5%]) to advanced (41 of 77 eyes [53.2%]). Overall, 59 patients (73.2%) were treated medically with up to 4 topical agents (40.0%). Of those treated, 70% of patients reported medication nonadherence during at least 1 visit. Medication nonadherence was more common among those taking 4 different topical medications (21 of 24) compared with others taking fewer medications (20 of 35). Nonadherence was more prevalent among those with advanced disease (22 of 26) compared with glaucoma suspects (6 of 13).

Nineteen office procedures, including laser peripheral iridotomy and laser trabeculoplasty, were performed on 14 eyes. Seventeen incisional glaucoma procedures were performed on 15 eyes, including glaucoma drainage device implant placement (11 procedures) and trabeculectomy (3 procedures). Only 26.6% of return office visits occurred within the recommended follow-up time frame. Moreover, 93 patients were seen more than 1 month after the recommended follow-up date.

The researchers concluded that, despite incarceration, during which medication administration and appointment attendance are theoretically strictly controlled, substantial medication and follow-up nonadherence exists among inmates.