Abstract
OBJECTIVE: To assess whether home environmental factors, including eyedrop storage location, local storage conditions (clutter, visual contrast, lighting), and trips to the storage room location, influence glaucoma medication adherence. DESIGN: Cross-sectional prospective study. PARTICIPANTS: A total of 93 community-dwelling adults with glaucoma aged ≥60 years with bilateral visual field damage from glaucoma. METHODS: Direct evaluation of the home and subsequent in-home monitoring of eyedrop nonadherence over a 7-day period using the Medication Event Monitoring System, which electronically recorded the date and time of eyedrop bottle openings. Room of medication storage (bedroom, bathroom, kitchen) and local conditions in the immediate area of eyedrop storage-lighting (measured in lux), clutter (graded via standardized rubric), and visual contrast (graded via standardized rubric)-were recorded. Trips to, and active time spent in, the eyedrop storage rooms were quantified using indoor positioning system technology, which continuously tracked participants' in-home movement. Multivariable multilevel logistic regression models identified environmental, clinical, and demographic factors contributing to weekly medication nonadherence, and nonadherence by time of day, and day of week. Other multivariable models assessed the relationship between time spent in, and transitions to, the eyedrop storage room and medication nonadherence. MAIN OUTCOME MEASURES: Medication Event Monitoring System-defined medication nonadherence (proportion of individual prescribed dose opportunities that were missed). RESULTS: Participants used 144 individual eyedrop medications, generating 1498 prescribed dose opportunities during the monitoring week. Overall, 15.3% of individual dose opportunities were missed. In multivariable analysis, kitchen storage (OR = 0.30, 95% CI: 0.11-0.86, P = .02) and bathroom storage (OR = 0.37, 95% CI: 0.14-0.95, P = .04) were associated with less nonadherence compared to bedroom storage. Evening medication doses had higher odds of nonadherence than morning doses (OR = 1.95, 95% CI: 1.25-3.03, P = .003). Lighting, clutter, and contrast of the medication storage area were not significantly associated with adherence, nor were active time spent in, or trips to, the room where medication was stored. CONCLUSIONS: Medication storage location and administration time significantly influence glaucoma medication adherence, while immediate environmental conditions around storage locations were less impactful. These findings suggest that integrating eyedrop medication routines with intentional spaces for medication storage, utilized early in the day, may improve adherence for older individuals with glaucoma.