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A Response to the Study “Lifestyle Counseling for Medication Adherence in Glaucoma” [Response to Letter]

Authors Kim S, Tong B, Lee J, Borodge D, Kooner K 

Received 22 December 2021

Accepted for publication 1 January 2022

Published 20 January 2022 Volume 2022:16 Pages 161—162


Sandy Kim,1 Betty Tong,1 Jessica Lee,1 Darara Borodge,1 Karanjit Kooner1,2

1Department of Ophthalmology, University of Texas Southwestern, Medical Center, Dallas, TX, USA; 2Department of Ophthalmology, Veterans Affairs North Texas Health, Care System, Dallas, TX, USA

Correspondence: Karanjit Kooner
Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9057, USA
Tel +1 214 648 – 4733
Fax +1 214 648 – 2270
Email [email protected]

View the original paper by Dr Kim and colleagues

This is in response to the Letter to the Editor

Dear editor

We wish to thank Dr. Lois Crabtree for his insightful comments regarding our paper, “Lifestyle Counseling for Medication Adherence in Glaucoma”.

Current literature has shown that there is indeed a significant association between low health literacy levels and glaucoma medication adherence as referenced in our study.1 We agree that our sample population who followed with one attending at a single academic Medical Center was skewed in terms of education as we found 70% of our population had a college education versus the reported half of the US population. However, there are other measures of health literacy besides education that were not able to be measured such as language preference, employment category, health insurance status, and income level which would further characterize a patient’s socioeconomic status - a measure that highly correlates to their health literacy.2,3 Including these measures may have helped us find associations that have been reported previously. Unfortunately, our sample size was not large enough to run regressions with certain categories such as education and employment broken up (ie homemaker, retired, unemployed, college degree vs graduate degree) - a limitation we acknowledge in the paper that may have led us to find differing results from the current body of literature.

To address your point on printed educational materials, our team designed the materials to be reader friendly with images and at an 8th grade reading level. Our intervention also consisted of reviewing these materials with the patient prior to sending them home with it with the goal of increasing their understanding and thus adherence to the printed information.


The authors report no conflicts of interest in this communication.


1. Boland MV, Chang DS, Frazier T, Plyler R, Friedman DS. Electronic monitoring to assess adherence with once-daily glaucoma medications and risk factors for nonadherence: the Automated Dosing Reminder Study. JAMA Ophthalmol. 2014;132(7):838–844. doi:10.1001/jamaophthalmol.2014.856

2. Muir KW, Santiago-Turla C, Stinnett SS, et al. Health literacy and adherence to glaucoma therapy. Am J Ophthalmol. 2006;142(2):223–226. PMID: 16876500. doi:10.1016/j.ajo.2006.03.018

3. Rikard RV, Thompson MS, McKinney J, et al. Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL). BMC Public Health. 2016;16:975. doi:10.1186/s12889-016-3621-9

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