Primary Open-Angle Glaucoma (POAG)
Conditions
Keywords
Primary Open-Angle Glaucoma, Medication Adherence, Mobile Reminder, SMS Reminder, WhatsApp Reminder, MMAS-8
Brief summary
This study evaluates whether a personalized mobile reminder program improves treatment adherence and clinical outcomes in adults with primary open-angle glaucoma (POAG) using topical antiglaucoma eye drops. Poor adherence to long-term eye-drop therapy is common in glaucoma care and may contribute to inadequate intraocular pressure (IOP) control and disease progression. Participants are randomized to either (1) a digital adherence intervention or (2) standard outpatient follow-up. The intervention consists of daily interactive SMS/WhatsApp medication reminders plus weekly brief educational messages for 3 months. The primary outcome is change in medication adherence measured by the Morisky Medication Adherence Scale-8 (MMAS-8) at month 3. Secondary outcomes include change in IOP, eye-drop instillation technique, and treatment satisfaction. Exploratory analyses assess the relationship between adherence level and OCT-based retinal nerve fiber layer (RNFL) progression metrics. The goal is to determine whether a low-cost, scalable mobile strategy can improve short-term glaucoma management in routine practice.
Detailed description
Primary open-angle glaucoma (POAG) is a chronic optic neuropathy in which sustained reduction of intraocular pressure (IOP) remains the main modifiable treatment target. In real-world care, nonadherence and incorrect eye-drop technique are frequent and can reduce treatment effectiveness. Digital reminder systems may improve adherence behavior; however, prospective randomized evidence in routine glaucoma clinics is still limited. This is a single-center, prospective, parallel-group, randomized controlled trial designed to assess the effectiveness of a personalized mobile reminder intervention in adults with POAG receiving topical antiglaucoma treatment. A total of 84 participants are allocated 1:1 to intervention or standard care. Intervention arm participants receive: Daily interactive medication reminders (SMS/WhatsApp) Weekly short educational messages focused on glaucoma, medication use, and practical adherence support Control arm participants continue standard outpatient follow-up without the digital reminder package. Follow-up duration is 3 months. The primary endpoint is change in MMAS-8 score from baseline to month 3. Secondary endpoints are change in IOP, change in correct eye-drop instillation technique, and treatment satisfaction. Exploratory analyses evaluate whether higher adherence is associated with more favorable OCT-derived RNFL slope patterns (global and quadrant-based estimates from retrospective imaging data). Planned statistical comparisons include between-group analyses using independent-samples t tests and adjusted analyses using ANCOVA. Analyses are performed on a complete-case basis for the 3-month follow-up period. Because of single-center design, modest sample size, and short follow-up, structural OCT findings are considered exploratory and hypothesis-generating.
Interventions
BEHAVIORALDigital Reminder Intervention
A behavioral adherence support intervention consisting of daily interactive SMS/WhatsApp reminders for eye-drop use and weekly educational reinforcement messages over 3 months.
Sponsors
Sakarya Yenikent State Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
This is an open-label behavioral intervention trial. Participants and treating clinicians are aware of assignment due to the nature of the mobile reminder intervention.
Intervention model description
Participants are randomized in a 1:1 ratio to either a personalized mobile reminder intervention (daily interactive SMS/WhatsApp reminders plus weekly educational messages) or standard outpatient follow-up for 3 months.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
Adults aged 18 to 75 years. Diagnosis of primary open-angle glaucoma (POAG) in at least one eye. Currently treated with at least one topical antiglaucoma medication. Able to read and understand study procedures and provide written informed consent. Has regular access to a mobile phone capable of receiving SMS or WhatsApp messages. Willing to comply with follow-up visits and study procedures for 3 month
Exclusion criteria
Secondary glaucoma (e.g., neovascular, uveitic, steroid-induced) or angle-closure glaucoma. Ocular surgery or laser procedure within the previous 3 months, or planned ocular surgery during study follow-up. Advanced ocular comorbidity likely to affect IOP assessment or adherence evaluation (e.g., severe corneal disease, active ocular infection/inflammation). Cognitive impairment, severe psychiatric disease, or communication barriers that prevent reliable participation. Inability to use or access mobile messaging tools required for the intervention. Participation in another interventional clinical study that may interfere with outcomes
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Medication Adherence | Baseline and Month 3 | Difference in Morisky Medication Adherence Scale-8 (MMAS-8) total score from baseline to month 3, and between-group comparison of mean change. Higher scores indicate better adherence. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Intraocular Pressure (IOP) | Baseline and Month 3 | Change in mean IOP (mmHg) from baseline to month 3 and adjusted between-group difference. |
Outcome results
None listed