News|Articles|March 4, 2026

Glaucoma Coaching Program Improved Medication Adherence

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Key Takeaways

A personalized coaching model integrating education, reminders, and adherence monitoring produced higher 6-month electronic adherence than periodic mailed materials plus usual care.
Nearly half of coached participants did not reach ≥80% adherence, but attainment was more than doubled versus control (54.9% vs 23.7%).
Glaucoma-related distress improved with coaching, whereas written education alone showed minimal change, supporting psychosocial benefit alongside behavioral adherence gains.
Similar intraocular pressure changes between groups suggest adherence improvements did not translate into short-term biologic differences within 6 months.
Higher loss to follow-up in the intervention arm and unadjusted site-level sociodemographic differences raise concerns about burden, confounding, and external validity in uninsured populations.

The Support, Educate, Empower intervention was able to reduce glaucoma-related distress compared with standard education.

Glaucoma medication adherence and glaucoma-related distress were both improved when patients used the Support, Educate, Empower (SEE) glaucoma coaching program vs the standard written education offered to patients with glaucoma, according to a study published in JAMA Ophthalmology.¹

Glaucoma is a leading cause of blindness across the globe² despite there being effective methods to slow its progression before it can cause permanent blindness. Experts project that 7.3 million people will have glaucoma by 2050, and adherence to the daily eye drop is a means of helping to address this influx of new glaucoma patients.¹ The SEE glaucoma coaching program was designed as a personalized glaucoma coaching program to help those who self-reported poor medication adherence. This study aimed to test the efficacy of the program compared with enhanced care control.

The nonmasked, 1:1 randomized clinical trial enrolled patients with glaucoma who were treated at the University of Michigan and Henry Ford Health System and were taking 1 or more ocular hypotensive eye drops. All patients were recruited between April 27, 2021, and December 18, 2023, and they were required to speak English to be a part of the study. Potential participants were mailed a recruitment letter, and all patients with an adherence below 85% were included in the recruitment process.

Participants were split into either the SEE intervention or the control group and followed for 6 months through July 31, 2024. Visual field testing was used to assess the severity of glaucoma in the participants. Nonphysician coaches delivered the SEE program to the group. The program included personalized multimedia glaucoma education, medication reminders, interviewing-based coaching, and medication adherence monitoring. There were also 3 in-person coaching sessions and 4 phone calls between visits. The control group received educational materials that were mailed to them every 2 months along with usual glaucoma care that was received by all participants. Adherence to medication was monitored electronically.

There were 235 participants enrolled, of whom 117 were in the SEE intervention and 118 were in the control group. The mean (SD) age of the cohort was 67.3 (10.9) years, and 53% were women. The cohort was predominantly Black (61.2%) and White (30.0%), and 97.1% reported no Hispanic heritage. Prescription drug coverage was available for most of the participants (93.0%). The mean percentage of adherence was 63.9% (17.9%), according to self-reports.

The SEE intervention group had significantly better medication adherence after 6 months of follow-up. The treatment group had a mean adherence of 77.6% (19.7%) compared with 58.0% (25.2%) in the control group. The control group also had decreasing adherence as time went on, whereas the treatment group was stable throughout the 6 months. A total of 54.9% of those in the treatment group had achieved adherence of 80% or more compared with only 23.7% of those in the control group.

Glaucoma-related distress also decreased in the intervention group from a mean distress score of 2.5 (0.9) to 1.9 (0.8) by the end of the study. The control group did not see a significant decrease in that same time period (2.4 [0.8] to 2.2 [0.9]). Change in intraocular pressure did not differ between the 2 groups. A total of 26 participants reported an adverse event.

There were some limitations to this study. Loss to follow-up was 23% in the intervention group compared with 9% in the control group, which could indicate a time burden for those in the intervention. Education, income level, and race also were different across the 2 sites, and they were not adjusted for in the main analysis. A total of 99% of the participants had health insurance, which could limit generalizability to the uninsured.

“The SEE personalized glaucoma coaching program demonstrated clinically significant improvements in glaucoma medication adherence and reductions in glaucoma-related distress compared with the control group receiving standard written education,” the authors concluded. Future studies will need to focus on biological outcomes and implementation process measures.

References

Newman-Casey PA, Niziol LM, Lu MC, et al. Effect of the Support, Educate, Empower personalized glaucoma coaching program on medication adherence: the SEE program randomized clinical trial. JAMA Ophthalmol. Published online February 26, 2026. doi:10.1001/jamaophthalmol.2026.0001
Glaucoma. Cleveland Clinic. Updated November 12, 2024. Accessed March 3, 2026. https://my.clevelandclinic.org/health/diseases/4212-glaucoma