A Response to the Study "Lifestyle Counseling for Medication Adherence in Glaucoma" [Letter].

Dear editor

Thank you to the authors of the study “Lifestyle Counseling for Medication Adherence in Glaucoma” for an interesting perspective on how to increase adherence to glaucoma medications.1

In this study, the authors note that there was no statistically significant difference in education status between adherent and non-adherent patients. However, previous literature has found a significant association between low literacy levels and poor adherence to medical treatment. This association has been evidenced in a study focusing on glaucoma medication adherence, and extends to other medical specialties including diabetic medications.2,3

In the United States of America 42% of the population have some form of a college degree.4 Within the population studied in this article, 70% of the 116 patients were college graduates. This poses a potential overestimation of the educational ability of patients when applying the results to the general population.

If the study participants chosen were representative of the levels of education within the general population, a statistically significant difference may have been discovered. This is an important study limitation to note, as underestimating the link between health literacy and medication adherence may compound health inequalities.

The study reports that patients were sent home with printed educational materials. Research has shown that the majority of ophthalmology based patient education materials are written at a level too difficult for the general population to understand.5 Health literacy must be considered if providing written and/or verbal counseling to improve glaucoma medication adherence in the general patient population. This will help ensure the information is understandable and accessible to all.