W. Lloyd Clark, MD: Ways to Improve Noncompliance


W. Lloyd Clark, MD, discusses the approaches he uses in his clinical practice to reduce patient noncompliance — specifically, when treating diabetic macular edema.

Few, if any, specialties in medicine have a problem with patient compliance that is as prominent as the issue has become in ophthalmology.

Despite shifting away from surgeries to less invasive injection therapies in recent decades, retina specialists and ophthalmologists often struggle to have patients return for additional treatments. W. Lloyd Clark, MD, sat down with MD Magazine® at the 2019 American Society of Retina Specialists Annual Meeting to discuss this issue.

Clark, a physician at Palmetto Retina Center, has more than 20 years of experience in clinical practice and has dealt with noncompliance so much he has designed a 2-phase approach to treatment with anti-VEGF agents. The approach allows Clark to properly inform patients on the importance of compliance — as he feels it can be the difference between a patient coming to a follow-up and becoming another contributor to the issue.

MD Mag: What are some ways physicians can improve patient compliance?

Clark: So, patient compliance has been a much bigger issue in this patient population than in some of the other patient populations we treat with anti-VEGF therapy — most notably age-related macular degeneration. It is a major concern for us, as we institute a therapy that is very effective but requires repeat treatment in order to have its desired clinical effect.

Education is critical in these patients. I tend to spend a lot of time, probably more time with my diabetic patients at the initiation of therapy to really try to explain to them the underlying disease process, what we're trying to achieve with intravitreal injections. the need for frequent injections early in the course of therapy and then we really lay out a road map for them.

I try to break DME therapy down now for these patients into 2 phases. the first phase is really sort of the first 6 months and most patients with diabetic macular edema — they're going to need fairly short interval, fixed-dosing for those first 6 months or so. In many patients after that, it can be extended. I asked them to give me 6 months of dedicated visits after explaining to them the importance of the disease and I think if you can break it down into shorter segments and be a little easier to digest from a patient stand point.

So, education is key. Hearing that message several times from the staff, from photographers, from reminders from the office. The key is just to continue to remind them of the importance and I think if we do that we're able to improve compliance in many patients.

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