Barriers and Enablers to Medication Adherence & Compliance in Glaucoma – A Scoping Review Protocol

Background Glaucoma is the leading cause of irreversible blindness worldwide, with increased intraocular pressure (IOP) being the primary modifiable risk factor. It is often referred to as the “silent thief of sight” for its progressive, mostly asymptomatic disease course until advanced stages. First line treatment is to lower IOP by topical medication. However, adherence to prescribed treatment is problematic, with only approximately 50% of patients taking their glaucoma medication one year post diagnosis. It is essential that patients commencing treatment be adherent since suboptimal adherence is reportedly related to poor clinical, social and economic outcomes. The aim of this review is to better understand the modifiable, influential factors (barriers and enablers to adherence), and the attempted interventions to improve adherence rates. Methods This scoping review will include searches in EMBASE, Medline, Psych Info, CINAHL and Web of Science electronic databases. Primary research studies and peer-reviewed grey literature will be eligible for inclusion, with no limitations on publication date. Studies not fully available in English will be excluded. Keywords developed from a population, concept, context framework will be used, and included glaucoma, topical therapy, adherence, barriers, enablers and interventions. Titles and abstracts will be screened for inclusion and full text screening of articles will be carried out independently by two reviewers. A data extraction framework will guide the literature screening. A qualitative data analysis will be carried out to assess relevant literature and data will be presented in a narrative synthesis format. Quality appraisal of the included studies will not be performed. Discussion These findings will advance our understanding of barriers and enablers to medication adherence in glaucoma. Findings will be relevant to patients, clinicians and stakeholders in the glaucoma care pathway. Evidence synthesised will also help inform the development of an educational tool to improve adherence as part of the overall project.