Factors influencing glaucoma medication adherence: A qualitative study in the United Kingdom using the Theoretical Domains Framework

Optom Vis Sci. 2026 Apr;103(4):e70054. doi: 10.1002/ovs2.70054.

ABSTRACT

PURPOSE: Long-term adherence to glaucoma medication is often suboptimal, compromising treatment efficacy and increasing the risk of glaucoma progression. Existing interventions have limited success. This study explored behavioral factors influencing adherence from the perspectives of United Kingdom (UK)-based patients with glaucoma and eye care professionals (ECPs), using the Theoretical Domains Framework (TDF).

METHODS: Semi-structured interviews were conducted with adults prescribed intraocular pressure-lowering eyedrops whose adherence status was classified based on self-reported medication use and UK-registered ECPs involved in glaucoma care. Interview data were analyzed using deductive and inductive thematic analysis guided by the TDF to identify key barriers and enablers influencing adherence-related behaviors.

RESULTS: Twenty-six participants were interviewed (13 patients and 13 ECPs). For patients, adherence was influenced by factors relating to knowledge and understanding of glaucoma, skills required to administer and obtain medication, memory and routine formation, beliefs about treatment necessity, social support, and healthcare system factors such as medication availability. ECPs identified time constraints, limited resources, and uncertainty in assessing adherence as key challenges, whereas communication skills, multidisciplinary support, and tailored decision-making were viewed as important enablers.

CONCLUSIONS: Glaucoma medication adherence is shaped by a complex interplay of behavioral, professional and systemic factors. Applying the TDF highlights modifiable influences on adherence and supports the development of targeted, theory-informed interventions to improve glaucoma outcomes.

PMID:42056712 | DOI:10.1002/ovs2.70054