A peer-level look at how ophthalmologists recognize adherence problems, manage ocular-surface disease and dosing burden, position selective laser trabeculoplasty, and decide when a non-drop strategy may offer a more sustainable path to IOP control.
Audience: Ophthalmologists
Countries: 6
Completion Rate: 71%
SGID: 8977449
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– Quick Read — Key Findings
Long-term glaucoma treatment asks patients to repeat a precise action every day, often for years, even when the disease itself may be asymptomatic.
For ophthalmologists, fluctuating IOP can reflect inadequate drug effect, progression, inconsistent dosing, poor technique, refill gaps, or ocular-surface intolerance, and adding another bottle before identifying the dominant problem can raise burden without restoring control.
Current guidance increasingly treats adherence, technique, tolerability, and burden as part of glaucoma management: NICE recommends checking adherence and instillation technique when IOP is inadequately controlled and positions 360° SLT as an initial option for selected newly diagnosed OHT and non-advanced COAG, and AAO evidence reviews support SLT as effective primary or supplemental therapy. The MDForLives survey examines how ophthalmologists recognize adherence problems, what drives them, and when treatment moves from topical therapy toward SLT or longer-acting delivery.
38.6% estimate that 26–50% of their glaucoma patients have meaningful difficulty maintaining long-term eye-drop adherence; another 24.6% place the proportion above 50%.
The distribution matters because adherence is not confined to a small, obviously non-adherent group; in many practices it becomes a routine source of uncertainty when IOP control or progression does not match the apparent plan. The key question is whether the regimen is failing biologically or the patient cannot sustain it as prescribed, and that distinction decides whether the next step is another drug, simpler dosing, surface-friendly therapy, technique support, or a non-drop strategy.
36.8% identify ocular surface disease, including burning, hyperemia, or chronic discomfort, as the primary driver of long-term eye-drop non-adherence.
Regimen complexity and treatment fatigue each account for 17.5%, while physical administration challenges and cost or refill barriers each account for 14.0%, and each barrier points to a different intervention. Surface discomfort may call for reducing preservative exposure, tremor or arthritis for a different delivery strategy, and repeated missed doses for simplification, so treating every adherence problem as a counseling problem risks missing the actual obstacle.
45.6% select a significant IOP discrepancy between routine visits and unplanned re-checks as the strongest indicator that suboptimal pressure may reflect non-adherence rather than medication failure.
Pharmacy or prescription refill history is the next clue at 24.6%, with fewer relying mainly on surface findings, stable fields or OCT despite fluctuating IOP, or poor in-clinic technique. No single clue proves non-adherence: pressure patterns, refill behavior, structural or functional testing, surface findings, and observed technique are best read together before deciding the medication itself has failed.
40.4% first consolidate therapy into once-daily dosing or a fixed-dose combination, while 38.6% move toward a procedural option such as SLT.
Consolidate to once-daily or fixed-dose combination
Move toward SLT or another procedural option
Switch to preservative-free medication
Introduce an administration aid or adherence device
The near tie captures the main strategic choice in adherence-focused glaucoma care: one path makes topical treatment easier, the other reduces how much the patient must do each day. Switching first to preservative-free medication accounts for 15.8% and using an administration aid for 5.3%, so ophthalmologists often respond by redesigning the treatment burden itself.
35.7% rapidly transition to preservative-free glaucoma medication when chronic topical therapy is associated with OSD, while 28.6% add concurrent dry-eye or other OSD treatment.
Another 21.4% reduce topical burden through SLT or another procedure, and elsewhere in the survey 40.0% use SLT first-line before topical therapy while a further 40.0% consider it early once non-adherence or OSD becomes evident. A 2024 systematic review also links chronic preservative exposure, particularly benzalkonium chloride, with ocular-surface disease and reports better tolerability with preservative-free approaches, so for some patients surface management and pressure management become the same design problem.
46.3% choose earlier use of SLT as part of initial glaucoma management as the development most likely to reduce long-term dependence on eye drops over the next 3–5 years.
Longer-acting sustained-release delivery follows at 25.9%, but earlier procedural care still meets friction: 44.4% name patient reluctance or concern about laser or procedural interventions as the biggest barrier to using these options sooner. The transition therefore depends on both technology and communication, since ophthalmologists need to explain expected duration, limitations, trade-offs, and the possibility of additional treatment before adherence has already failed.
Glaucoma adherence sits at the intersection of pressure control, tolerability, technique, regimen complexity, patient behavior, and a disease that may not feel urgent day to day, so no single intervention solves every barrier.
The survey suggests that ophthalmologists are already redesigning care around that reality: checking pressure discordance and refill behavior, simplifying dosing, reducing preservative or topical burden, and bringing SLT into the pathway before adherence has clearly failed.
The unresolved question is how early to make that transition. Earlier SLT leads the future direction, with sustained-release delivery also expected to reduce daily drop dependence, though patient reluctance, uncertainty about duration, reimbursement, access, and disease fit still shape what is possible. The opportunity is to treat adherence as a clinical design problem: identify the barrier and choose the least burdensome pathway that can still deliver the required IOP control.
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Direct answers to common clinical questions about adherence, ocular-surface disease, SLT, preservative-free therapy, and sustained-release glaucoma treatment.
Direct answers to the questions healthcare professionals are most likely to ask about these findings.
