Systematic literature review on strengthening eye care follow-Up among glaucoma patients in Limpopo Province

Author: Tshivhase S.

Geographical coverage: Not reported

Sector: Glaucoma

Sub-sector: Treatment adherence

Equity focus: Not reported

Study population: Patients with glaucoma

Review type: Effectiveness review

Quantitative synthesis method: Narrative synthesis

Qualitative synthesis method: Not applicable

Background 

Poor medication adherence is a major contributor to glaucoma-related vision loss, with adherence rates for chronic glaucoma ranging from 43 % to 78 % worldwide. Studies indicate that lowering intra‑ocular pressure (IOP) through medication can reduce the risk of glaucomatous progression by 40 %–50 %. The World Health Organization reports that adherence to long‑term therapies is about 50 %, and even lower in developing countries. Numerous interventions have been developed to improve adherence, but their success has been mixed.

Objectives 

To identify and appraise studies that evaluated interventions designed to strengthen glaucoma medication adherence, and to rate their effectiveness by quality of outcome measures.

Main findings 

Electronic and personalised educational interventions show promise for improving medication adherence.

Sixteen studies met the inclusion criteria: 11 randomised controlled trials (RCTs), four observational studies and one mixed‑methods study. Five of the 11 RCTs (45 %) reported significant improvements in adherence using electronic reminders, educational sessions or motivational counselling. Behavioural counselling and personalised care plans enhanced adherence by empowering patients and building self‑management skills. Electronic interventions, including SMS reminders, voice calls and automated devices, consistently increased adherence compared with standard care. Tailored educational materials improved adherence among patients with low literacy.

Observational studies mainly employed pre–post designs; only one demonstrated a significant improvement. Group‑based programmes and eye‑drop charts yielded inconsistent results. Motivational interventions were effective but produced smaller gains than automated reminders and required specialist training for health professionals.

Methodology 

Searches of Sabinet, EBSCOhost, ScienceDirect, MEDLINE and Google Scholar identified peer‑reviewed RCTs and observational studies published in English between 2009 and 2019. Studies had to recruit adults with glaucoma, compare an educational or behavioural adherence intervention with a control, and enrol at least 50 participants.

Titles, abstracts and full texts were screened against the inclusion criteria, and data were extracted using a standardised form. Study quality was assessed with the Jadad score (RCTs) and the Newcastle–Ottawa Scale (observational studies). Findings were synthesised narratively.

Applicability / external validity 

Most studies were conducted in high‑income countries and none evaluated community‑ or family‑based strategies. Evidence for culturally relevant approaches in Africa is lacking.

Geographic focus 

The location of included studies was not reported by the review authors.

Summary of quality assessment 

Confidence in the review’s conclusions is low owing to missing methodological details. The authors did not list excluded studies, report the number of reviewers involved in screening or data extraction, check reference lists, or contact study authors for clarification. Results were not stratified by risk of bias.