All 15 participants contributed data to both phases of the trial. The prespecified primary outcome was non-invasive tear break-up time, measured with an OCULUS Keratograph 4M. Tear meniscus height and symptom scores were secondary outcomes.

Researchers analyzed the results using two-way analysis of variance and post-hoc Bonferroni tests to adjust for multiple comparisons. The trial was registered at ClinicalTrials.gov under the identifier NCT07618169. Across the observed visits, the USB-powered device was associated with a likelihood-ratio chi-square value of 7.43 for tear break-up time, with p = 0.006.

It also had a significantly higher tear meniscus height, with a chi-square value of 4.49 and p = 0.034. On day 5, descriptive mean tear break-up time was 9.53 ± 2.18 seconds with the USB-powered compress and 7.21 ± 2.90 seconds with the self-heating mask. Mean tear meniscus height was 0.200 ± 0.020 millimeters and 0.188 ± 0.016 millimeters, respectively.

SPEED symptom scores showed mild improvement in mean values but no significant difference between devices, and no adverse events were reported. The investigators concluded that USB-powered warm compresses provided superior results for tear film stability and volume compared with self-heating masks, describing temperature control and reusability as advantages of the powered devices. However, the evidence comes from a small cohort of young adults treated for two five-day periods.

The study was not designed to establish longer-term effectiveness, and larger trials would be needed to confirm whether the observed differences are reproducible in broader populations. The findings support further investigation of USB-powered compresses as an at-home treatment for meibomian gland dysfunction, rather than definitive conclusions about their clinical superiority.

Subject of Research: Comparative effects of USB-powered and self-heating warm compresses on tear film measures in adults with meibomian gland dysfunction

Article Title: USB-powered vs. self-heating warm compresses for meibomian gland dysfunction: A prospective randomized crossover clinical trial

Article References: Al Saqr, A. M., Alharbi, M. F., Alrumizan, M., & Abusharha, A. (2026). USB-powered vs. self-heating warm compresses for meibomian gland dysfunction: A prospective randomized crossover clinical trial. PLOS One, 21(10), e0360762. https://doi.org/10.1371/journal.pone.0360762

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360762

Keywords: meibomian gland dysfunction, dry eye, warm compress therapy, tear break-up time, tear meniscus height, USB-powered device, self-heating mask, randomized crossover trial, eye health, USB-powered, self-heating, warm

Researchers from Al-Quds University, Palestine Polytechnic University, Hebron University, and the Palestinian Ministry of Health surveyed 741 adults across the West Bank and Jerusalem between December 1 and December 30, 2025, using an online questionnaire distributed through social media. The instrument covered sociodemographics, awareness, knowledge, attitudes, and eye-care practices, and it was translated into locally adapted Arabic and piloted with 30 respondents. The eight-item knowledge scale showed strong internal consistency, with a Cronbach’s alpha of 0.87, and knowledge was scored out of eight points with good knowledge defined as at least six correct answers. Data were analyzed in SPSS version 23 using chi-square tests and multivariable logistic regression, and the final sample far exceeded the minimum required size of 384 participants.

The headline numbers reveal a striking disconnect between recognition and understanding. Just over half of participants, 54 percent, had heard of glaucoma, a level of name recognition that actually exceeds figures reported in neighboring Jordan, where awareness stood at 38 percent, and in Riyadh, Saudi Arabia, at 37.8 percent. Yet when the researchers tested genuine comprehension, only 13.8 percent of participants demonstrated good knowledge under a strict cutoff requiring at least seven correct answers, and just 33.9 percent met the more lenient threshold of six. The mean knowledge score was a modest 3.62 out of 8, and 27.1 percent of respondents scored zero, while only 6.2 percent achieved a perfect score.

The item-level results expose precisely where public understanding breaks down, and the failures cluster around the clinical features that matter most for early detection. Only 20.9 percent of participants correctly rejected the idea that glaucoma usually announces itself with noticeable early symptoms such as pain or redness. Roughly 29 percent actively believed that misconception, and another 50 percent were simply not sure. Equally troubling, only 20.9 percent recognized that glaucoma cannot be completely cured with full reversal of vision loss. That figure compares poorly with neighboring Jordan, where 52.2 percent of participants in a prior study correctly identified glaucoma as treatable but not curable. Because the disease damages the optic nerve irreversibly, these two misconceptions together create a false sense of security that can delay diagnosis until permanent damage is done.

Knowledge of risk factors was similarly patchy. Just 49 percent of respondents knew that adults aged 40 and older face elevated risk, 44.9 percent recognized family history as a risk factor, and 55.1 percent identified diabetes, the best-recognized of the three, likely reflecting broader public health messaging about diabetic complications. On the positive side, 64.4 percent correctly understood that early treatment can prevent further vision loss, and 57 percent knew that untreated glaucoma can cause irreversible blindness. Notably, having a chronic disease was not associated with better glaucoma knowledge in this sample, despite 12.1 percent of participants reporting chronic conditions, a finding that echoes detailed knowledge results from Saudi Arabia even where raw awareness differed.

Who understood glaucoma best was one of the study’s most telling findings. Prior awareness of having heard of the disease was by far the strongest predictor of good knowledge, with an adjusted odds ratio of 7.89, meaning participants who had previously encountered the term were nearly eight times more likely to answer knowledge questions correctly. But even within that group, only 22.8 percent achieved good knowledge, underscoring that hearing a disease name and understanding its behavior are two very different levels of health literacy. Age, education, and geography also mattered. Participants aged 55 and older had substantially lower odds of good knowledge compared with those aged 18 to 24, with adjusted odds ratios as low as 0.06 under the strict definition, and those with only a high school education scored significantly below bachelor’s degree holders. Urban residents had nearly double the good-knowledge rate of rural villagers and camp residents, 17 percent versus 8.7 percent, an independent association confirmed in regression analysis, and the gap likely reflects the concentration of healthcare services and health campaigns in cities.

The behavioral consequences of these knowledge gaps show up plainly in the eye-care data. Only 26.9 percent of participants had undergone a comprehensive eye examination within the preceding year, nearly a quarter reported never having had any such examination, and 35.1 percent had never been examined at all. Perhaps most revealing, having previously had an eye exam was not significantly associated with better glaucoma knowledge, which the authors interpret as evidence that routine clinical visits in Palestine are not being used to educate patients about the disease. Intentions, by contrast, tracked knowledge closely: participants who said they would definitely follow a provider’s recommendation for screening had a good-knowledge rate of 16.3 percent, compared with 3.8 percent among those who would probably not go and zero percent among those who would definitely not go, a statistically significant association.

The study is the first to assess glaucoma awareness in the general Palestinian population, and its findings sit within a global pattern of poor eye-health literacy. Comparable surveys have found that only 13.1 percent of participants in the Maldives recognized glaucoma’s potentially asymptomatic course, while studies in rural North India and Germany documented similar misconceptions that glaucoma must cause pain or blurred vision to be present. This convergence across widely different health systems suggests the problem is structural rather than local: glaucoma’s asymptomatic progression defeats the intuitive human strategy of waiting for symptoms before seeking care. The international data, including regional reports that up to 36 percent of primary open-angle glaucoma patients and 70 percent of primary angle-closure glaucoma patients were already blind at examination in some population-based studies, illustrate what happens when detection depends on symptom recognition.

The authors are candid about their study’s limitations. The non-probability, voluntary-response online sampling means the sample skewed young, with 49.9 percent of participants aged 18 to 24, highly educated, with 62.1 percent holding bachelor’s degrees, and urban, with 61.3 percent living in cities. Because those same characteristics were associated with better knowledge, the observed figures likely overestimate the true knowledge levels of the broader Palestinian adult population, and the true gaps among older, rural, and less educated groups may be even wider than reported. The authors emphasize that the prevalence estimates should not be read as population-representative, though the internal associations between demographics and knowledge remain robust and warrant confirmation in probability-sampled studies.

The practical implications are clear. Awareness campaigns that stop at teaching the name of the disease are not enough, the researchers argue, because fewer than one in seven people who recognize the term understand the disease’s silent progression, its irreversibility, or who is at risk. They propose embedding glaucoma education into routine clinical consultations, training ophthalmologists and primary care physicians to discuss the disease at every visit, and deploying community health workers and mobile screening programs to reach older adults, rural residents, and people with lower educational attainment, the very groups whose knowledge scores were lowest and whose risk of preventable blindness is highest. Given that glaucoma is a leading cause of irreversible blindness worldwide, affecting more than 3.6 million blind individuals globally, closing the gap between knowing the word and knowing the disease may be one of the most cost-effective interventions available to protect sight in Palestine and beyond.

Subject of Research: Public awareness and knowledge gaps regarding glaucoma among adults in Palestine

Article Title: Knowledge gaps and practices for glaucoma among adults in Palestine: a cross-sectional study

Article References: Awlad Mohammad, M. W., Bader, B., Sayes, M. F., Amro, A. M., Awlad Mohammad, T. W., Hasheem, E., Amro, M., Mosameh, D. M., Amwas, D., Qawasmeh, A., & Abu Sham’a, F. K. (2026). Knowledge gaps and practices for glaucoma among adults in Palestine: a cross-sectional study. Frontiers in Ophthalmology, 6, Article 1953940. https://doi.org/10.3389/fopht.2026.1953940

Image Credits: AI Generated

DOI: 10.3389/fopht.2026.1953940

Keywords: glaucoma, Palestine, eye health, public awareness, blindness prevention, cross-sectional study, health literacy, screening, optic neuropathy, risk factors, West Bank, public health

The study, led by Ngozi Precious Uwagboe and colleagues, was conducted between April 11 and June 22, 2025. Adults were recruited through optometry clinics and community outreach programmes, then asked to view a series of culturally tailored educational videos. Each video addressed at least one major eye condition—myopia, cataract, or glaucoma—as well as general eye health topics, including common myths and preventive practices. The design was a pre-post pilot: participants’ knowledge and intentions were measured before and immediately after the intervention, and changes were assessed using paired statistical comparisons, with additional subgroup analyses stratified by educational attainment.

The 438 participants who took part were predominantly young and relatively well educated. According to the study, 77.7 percent were aged 18 to 44 years, 52.5 percent were female, and 75.1 percent had higher education. Notably, 80.0 percent already reported existing health-promoting behaviours, and 79.7 percent considered regular eye examinations important before the intervention began. This baseline matters: when a population starts with fairly positive attitudes, there is limited room for improvement, making any measurable gains in knowledge and intention all the more meaningful.

The headline finding concerns perceived knowledge. Before watching the videos, only 42.0 percent of participants rated their eye health knowledge as good; afterwards, that figure rose to 68.0 percent—an absolute increase of 26.0 percentage points and a relative increase of 61.9 percent, which reached statistical significance with a p-value of 0.013. The effect size, measured by Cramér’s V of 0.279, indicates a moderate association between the intervention and the change in self-assessed knowledge. In practical terms, participants did not merely sit through the videos; they came away feeling substantially better informed about their eyes.

More importantly, the gains were not purely a matter of confidence. Objective eye health knowledge scores—measured through factual questions rather than self-report—increased by 52.4 percentage points, also statistically significant at p = 0.013, though with a smaller effect size (Cramér’s V = 0.069). The divergence between the two effect sizes is instructive: participants’ subjective sense of learning outpaced the measurable knowledge gain, a pattern common in educational interventions. Still, a jump of more than fifty percentage points in tested knowledge after a single video package is a remarkable immediate effect for any health education tool, let alone one delivered through an artistic medium.

Behavioural intentions moved in the same direction. Participants reported increased willingness to adopt protective practices, including wearing sunglasses, reducing screen time, and attending regular eye examinations. The overall intention to visit an eye clinic rose by 10 percent, although this particular change did not reach statistical significance (p = 0.443). The authors attribute this plateau to a ceiling effect: with nearly 80 percent of participants already valuing regular eye examinations at baseline, there was little room for the aggregate figure to climb further. In other words, the intervention may have consolidated existing intentions rather than creating new ones—a valuable outcome in its own right.

Where the intervention truly distinguished itself was among participants with lower educational attainment. The largest improvements in willingness to attend regular check-ups occurred among those with secondary education, whose willingness surged from 27.5 percent to 96.3 percent (p < 0.001), and among those with primary or no formal education, whose willingness rose from 41.4 percent to 96.6 percent (p < 0.001). These are extraordinary shifts. Health communication frequently struggles to reach people outside formal educational systems, because written materials and jargon-heavy messaging assume literacy and familiarity with medical concepts. Dance, by contrast, is culturally embedded and universally accessible, transmitting information through rhythm, narrative, and visual demonstration rather than text.

The implications for global eye health are considerable. Vision impairment affects hundreds of millions of people worldwide, and a large share of the burden is preventable or treatable—cataract surgery, glaucoma management, and refractive error correction are among the most cost-effective interventions in medicine. Yet in many low- and middle-income countries, people present late, when conditions have already advanced, often because they do not recognise symptoms, hold misconceptions about causes, or underestimate the value of routine examination. Myths about eye health, from harmful traditional remedies to fatalism about vision loss, remain widespread. An educational medium that can dismantle these barriers without requiring literacy, and that people actively enjoy, addresses one of the stubborn bottlenecks in preventive eye care.

The study’s multimodal design deserves attention as well. By combining music, dance, and structured educational content, the video package engaged multiple channels of communication simultaneously—emotional, narrative, and factual. Research in health psychology has long suggested that messages delivered through engaging, culturally congruent formats are better remembered and more persuasive than purely didactic ones. The Nigerian context, with its rich traditions of music and dance as vehicles for storytelling and social commentary, makes the approach especially well suited. The videos did not treat culture as decoration; they treated it as the delivery system itself.

As a pilot study, the research has clear limits that the authors and readers must weigh. The sample was young, urban-leaning, and highly educated, with strong baseline health behaviours—hardly the population with the greatest unmet eye health needs. The measurements captured immediate effects only, not whether participants actually booked appointments, wore sunglasses, or reduced screen time weeks or months later. The non-significant change in clinic-visit intention illustrates how ceiling effects can mask or dilute impact. Future studies will need to follow participants over time, reach populations with lower baseline engagement, and test whether the dance-integrated format retains its power at scale and across different cultural settings. Even so, the direction of the findings is compelling: knowledge rose sharply, intentions strengthened most where they were weakest, and the medium itself proved feasible to deploy in clinics and community outreach. If subsequent trials confirm these effects, dance-integrated video education could become a low-cost, high-reach tool for eye health promotion—proof that sometimes the most effective public health technology is not a new drug or device, but a well-told story set to music.

Subject of Research: Dance-integrated educational videos for improving eye health knowledge and preventive intentions among Nigerian adults

Article Title: Feasibility and immediate effects of a multimodal, dance-integrated educational video package on eye health knowledge and intentions in Nigeria: A pre-post pilot study

Article References: Uwagboe, N. P., Obia, A. I., Nwaolai, O. L., Gadimoh, P., Alari, E. O., Yanney, C. N., Eseme, N. J., & Osuagwu, U. L. (2026). Feasibility and immediate effects of a multimodal, dance-integrated educational video package on eye health knowledge and intentions in Nigeria: A pre-post pilot study. PLOS Global Public Health, 6(10), e0005585. https://doi.org/10.1371/journal.pgph.0005585

Image Credits: AI Generated

DOI: 10.1371/journal.pgph.0005585

Keywords: eye health, health education, dance, Nigeria, public health, glaucoma, cataract, myopia, health communication, pilot study, preventive behaviour, global health

Myopia, or near-sightedness, is a refractive error in which the eyeball grows too long relative to the focusing power of its optical system. When the axial length of the eye exceeds the distance at which the cornea and lens can bring light to a focus, distant images land in front of the retina instead of directly on it, blurring far vision while near vision remains sharp. The condition typically emerges in childhood, progresses through adolescence and often stabilises in early adulthood. Spectacles and contact lenses can correct the blurred vision, but they do nothing to reverse the underlying structural elongation of the eye, which is the true source of long-term risk.

That structural change matters because a longer eye is a more fragile eye. Excessive axial elongation stretches the retina and its supporting tissues, sharply raising the lifetime risk of cataract, open-angle glaucoma, myopic macular degeneration and retinal detachment. Each of these complications can cause irreversible vision loss, and their management places a heavy load on patients and health systems alike. Globally, the burden of vision impairment from uncorrected myopia was estimated at US$244 billion in 2015, a figure expected to climb as prevalence rises. Projections cited in the study suggest that 1.4 billion people were myopic in 2000 and that 4.8 billion, more than half of humanity, could be by 2050.

The new analysis was designed to fill a conspicuous gap. Most large-scale myopia epidemiology has focused on Asian populations, where prevalence in some urban settings reaches 80 to 90 percent among young adults. European data existed but were fragmented: earlier population-based studies reported prevalence ranging from 27 percent in the United Kingdom to 39 percent in France, and a recent meta-analysis of 14 European countries found estimates varying from 11.9 percent in Finland to 49.7 percent in Sweden. To cut through this heterogeneity, the E3 Consortium researchers used individual participant data rather than published summary statistics, harmonising refraction measurements across 28 studies collected between 1990 and 2024.

Methodologically, the team defined myopia as a spherical equivalent of refraction of -0.50 dioptres or worse, following International Myopia Institute criteria, and subdivided cases into low, moderate and high myopia. Participants born between 1900 and 2000 were grouped into birth decades, and pooled prevalence estimates for each decade were derived using random-effects meta-analysis with inverse variance weighting and restricted maximum likelihood estimation. People with artificial lenses or a history of refractive surgery were excluded, as were those with retinal detachment from the axial length analysis, since surgery can alter eye dimensions. Strata with fewer than 50 observations were dropped to keep estimates robust.

The headline result is stark: myopia prevalence more than tripled across twentieth-century birth cohorts, with the steepest acceleration occurring from the 1950s onward. Low myopia climbed from 12.5 percent in the 1900s cohort to 35.0 percent in the 1980s cohort, moderate myopia from 3.3 percent to 11.4 percent, and high myopia from 2.2 percent to 3.9 percent. When the decade-specific estimates were weighted according to the actual age structure of the European population, the standardised prevalence for 2024 came out at 42.7 percent, well above the consortium’s earlier estimate of 30.6 percent and approaching the widely cited global projection of 50 percent by mid-century.

Perhaps the study’s most important technical contribution is its demonstration that the generational rise is written into the physical dimensions of the eye itself. Analysing axial length data from 56,876 participants, the researchers found that every percentile of the distribution, from the 5th to the 95th, shifted longer across birth cohorts from the 1920s to the 1970s. Between the 1920s and 1970s cohorts, mean axial length increased by 0.49 millimetres at the 5th percentile and 1.05 millimetres at the 95th percentile in men, and by 0.37 and 0.67 millimetres respectively in women. This population-wide shift indicates not merely that more people cross the myopia threshold, but that eyes in general are getting bigger, including among people who would otherwise be long-sighted or only mildly myopic.

Some of that elongation could reflect simple growth: axial length correlates with body height, adding roughly 0.03 millimetres per centimetre of stature, and Europeans gained about one centimetre of height per decade over the last century. But that accounts for only 0.03 millimetres of axial growth per decade, whereas the observed increase at the median was 0.07 millimetres. The remainder points to environmental drivers, chief among them the modern lifestyle of prolonged near work, reading and screen use combined with limited time outdoors, patterns amplified by extended years in education. Intriguingly, the sex pattern also shifted: men born in the early twentieth century were slightly more myopic than women, but the trend reversed after the 1950s, a crossover the authors link to rising female participation in higher education and its associated near-work demands.

The authors are careful about the limits of their data. Between-study heterogeneity was substantial, with the I-squared statistic often exceeding 90 percent, meaning pooled figures should be read as averages across diverse settings rather than a single number applicable everywhere. Non-cycloplegic refraction can slightly overestimate myopia through residual accommodation, though recent work suggests the effect, around 0.31 dioptres in young adults, is unlikely to have changed classification across the broad severity categories. And because cohorts born after 2000 were excluded, the youngest generations, whose eyes may not yet have finished elongating, remain outside the analysis; an apparent dip in axial length in the most recent cohorts likely reflects incomplete growth rather than a genuine reversal.

Even with those caveats, the trajectory is unmistakable and the implications are serious. If prevalence continues to climb, Europe faces not only more spectacle prescriptions but a growing reservoir of high myopia and its attendant complications, threatening irreversible vision loss in working-age adults and straining ophthalmic services. The study’s authors argue that the evidence now justifies preventive strategies targeting modifiable environmental risk factors, particularly increasing time spent outdoors and reducing prolonged near work in children, alongside continued evaluation of clinical interventions designed to slow myopia progression. What was once an inconvenience corrected by a pair of glasses is, on current trends, becoming one of the century’s most consequential chronic eye diseases, and the generations now in school will determine just how heavy that burden becomes.

Subject of Research: Temporal trends in myopia prevalence and axial length across European birth cohorts

Article Title: The growing burden of myopia in Europe: evidence from population-based cohorts

Article References: Tiemens, A., van Hemert, D. J., Lemma, S. T., Quist, S. W., Shi – van Wielink, K., Agius, D., Arnould, L., Berendschot, T. T. J. M., Beuse, A., Bikbov, M. M., Birtel, J., Bountziouka, V., Breteler, M. M. B., Carbonaro, F., Chakravarthy, U., Coimbra, R., de Vries, V. A., Delcourt, C., Farinha, C., … Lotery, A. J. (2026). The growing burden of myopia in Europe: evidence from population-based cohorts. European Journal of Epidemiology. https://doi.org/10.1007/s10654-026-01435-w

Image Credits: AI Generated

DOI: 10.1007/s10654-026-01435-w

Keywords: myopia, axial length, refractive error, epidemiology, birth cohorts, E3 Consortium, Europe, public health, high myopia, vision impairment, meta-analysis, eye health

The research, published in BMC Health Services Research, was conducted by a team led by Ravi Dhar Bhandari of Dhangadhi Netralaya Eye Hospital together with colleagues from the Tilganga Institute of Ophthalmology in Kathmandu. Their focus was a specific behavior known in the health services literature as cost-related non-adherence, abbreviated CRNA. The concept is deceptively simple: a patient is considered cost-related non-adherent if, within a defined period, they engaged in at least one cost-saving behavior related to their medication. That might mean skipping doses to make a bottle last longer, taking drops less frequently than prescribed, delaying a refill until money becomes available, or using a cheaper substitute without medical guidance. Each of these behaviors may seem minor in isolation, but in a disease where sustained intraocular pressure control is the only proven way to preserve vision, even intermittent lapses can translate into permanent nerve damage.

To measure how often this happens, the researchers designed a cross-sectional study running from 1 October 2023 to 31 March 2024 at Dhangadhi Netralaya, a major eye hospital serving Sudurpaschim Province. They enrolled consecutive patients aged eighteen or older who had been receiving topical glaucoma medication for at least six months, a threshold chosen to ensure that participants had enough experience with their treatment regimen to report on it meaningfully. Data came from two sources: a structured questionnaire capturing sociodemographic information and medication-related behaviors, and a review of medical records for clinical details such as diagnosis, visual acuity, and the number of medication bottles prescribed. The study received ethics approval from the Ethical Review Committee of the Nepal Health Research Council under protocol reference number 54, and every participant provided written informed consent before enrollment, in accordance with the Declaration of Helsinki.

The final cohort comprised 132 patients, of whom 60.6 percent were male, with a mean age of 60.1 years and a standard deviation of 12.6 years. Primary open-angle glaucoma, the most common form of the disease worldwide, accounted for 65.9 percent of diagnoses, with angle-closure variants and secondary glaucomas making up the remainder. The burden of visual loss in this group was striking even before adherence was considered: 53.0 percent of participants already had some degree of visual impairment, and 15.2 percent were blind. These figures underscore a broader reality of glaucoma care in low-resource settings, where patients frequently present late in the disease course, when much of the damage cannot be undone. Against this backdrop, any additional barrier to effective treatment, including cost, becomes a matter of profound consequence.

The headline finding was that 14 of the 132 participants reported at least one cost-saving behavior with their glaucoma medications in the preceding six months, yielding a prevalence of cost-related non-adherence of 10.6 percent, with a 95 percent confidence interval ranging from 6.1 to 17.5 percent. In other words, roughly one in ten patients in this cohort was compromising their glaucoma therapy for financial reasons. The authors are careful to frame this as a conservative estimate for a single hospital population, but the proportion is clinically meaningful: every one of those ten percent represents a person whose optic nerve is exposed to pressure fluctuations that could accelerate vision loss. The confidence interval also indicates genuine statistical uncertainty inherent in a sample of this size, a limitation the researchers acknowledge by presenting the estimate transparently rather than overstating its precision.

Perhaps the most technically interesting part of the study lies in its analysis of which patients were most at risk. The team first performed bivariate analyses examining the raw associations between cost-related non-adherence and a range of potential predictors, then moved to multivariable logistic regression to adjust for confounding variables and isolate independent risk factors. Three factors emerged with statistical significance at the conventional threshold of a p-value below 0.05. Patients with systemic comorbidities, meaning coexisting conditions such as diabetes, hypertension, or other chronic illnesses requiring their own treatment expenses, had dramatically higher odds of cost-related non-adherence, with an adjusted odds ratio of 23.05 and a 95 percent confidence interval spanning 2.32 to 374.36. The very width of that interval reflects the small number of affected patients, but the direction and magnitude of the association tell a coherent story: households juggling multiple chronic diseases face compounding out-of-pocket costs, and when budgets are stretched, eye drops that produce no felt benefit are among the first expenses to be cut.

The second independent predictor was the number of glaucoma medication bottles prescribed. Most participants, 62.9 percent, were prescribed a single bottle, while 28.8 percent were prescribed two and 8.3 percent were prescribed three. Each additional bottle multiplied both the direct cost and the logistical complexity of the regimen, and patients on multi-bottle therapy had an adjusted odds ratio of 6.76 for cost-related non-adherence, with a confidence interval of 2.31 to 25.73. This finding aligns with a well-established principle in adherence research: regimen complexity is one of the most reliable predictors of non-adherence across virtually every chronic disease, from HIV to hypertension to glaucoma. Every additional medication adds a set of instructions, a schedule, and a price tag, and in a setting where patients typically pay out of pocket, the financial gradient is steep.

The third finding was more counterintuitive. Male sex was associated with significantly lower odds of cost-related non-adherence, with an adjusted odds ratio of 0.11 and a confidence interval of 0.02 to 0.55. Given that men made up the majority of the cohort, this suggests that women in this population face disproportionate financial barriers to sustaining their glaucoma therapy. The authors do not over-interpret this result, but it resonates with a substantial body of literature from South Asia documenting gender inequities in healthcare access and expenditure, where women’s health needs are often deprioritized within household spending decisions. Whether the mechanism in Sudurpaschim Province reflects income disparities, decision-making dynamics, or other factors is a question the study raises but cannot fully resolve, and it is precisely the kind of question that deserves targeted follow-up research.

It is worth pausing on why these findings matter beyond Nepal. Glaucoma is the leading cause of irreversible blindness globally, and the World Health Organization has projected that the burden of blinding eye disease will grow as populations age. In high-income countries, cost-related non-adherence to glaucoma drops is also documented, but insurance coverage, generic options, and pharmaceutical assistance programs provide buffers that simply do not exist in many low- and middle-income settings. In far-western Nepal, where geographic isolation, limited transportation infrastructure, and low household incomes compound the challenge, the out-of-pocket cost of a bottle of topical medication can represent a substantial fraction of a family’s monthly budget. The study’s finding that more than half of enrolled patients already had visual impairment, and one in seven was blind, paints a picture of a population arriving at care late and then struggling to sustain it.

The authors conclude with a set of practical implications that follow directly from their data. Because cost-related non-adherence affected approximately one in ten patients, and because the strongest risk factors were systemic comorbidities and multi-bottle regimens, interventions can be targeted with reasonable precision. Strategies to reduce out-of-pocket costs, whether through subsidized medication supply, inclusion of glaucoma drops in essential drug programs, or tiered pricing at charitable eye hospitals, would address the financial barrier at its root. Simplifying treatment regimens where clinically feasible, for example by favoring combination drops that consolidate multiple medications into a single bottle, would simultaneously lower cost and reduce complexity. Clinicians could also screen for cost-related non-adherence proactively, asking patients directly whether they have stretched or skipped drops for financial reasons, since patients rarely volunteer this information unprompted. As a modifiable barrier, medication cost stands apart from demographic risk factors that cannot be changed, which is what makes this modest study of 132 patients in far-western Nepal a small but genuinely actionable piece of the global effort to prevent avoidable blindness.

Subject of Research: Cost-related non-adherence to topical glaucoma medication among patients in far-western Nepal

Article Title: Cost-related non-adherence to glaucoma medical therapy: a hospital based study in Sudurpaschim Province of Nepal

Article References: Bhandari, R. D., Bist, J., Poudel, M., Pant, O. P., & Pant, B. P. (2026). Cost-related non-adherence to glaucoma medical therapy: a hospital based study in Sudurpaschim Province of Nepal. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15788-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15788-1

Keywords: glaucoma, cost-related non-adherence, medication adherence, Nepal, eye health, ophthalmology, health services research, out-of-pocket costs, visual impairment, primary open-angle glaucoma, treatment regimen complexity, low-resource settings