Background/Objectives: We aimed to evaluate nonadherence to topical glaucoma therapy and identify risk factors for repeated prescription fulfillment failure in a large national population-based cohort. Methods: The electronic medical records from a large health maintenance organization were retrospectively reviewed for all patients aged 18 years or older with a diagnosis of glaucoma from 2000 to 2023. Data on patients who had purchased at least one anti-glaucoma medication were retrieved. Compliance was defined as prescription fulfillment within predefined expiration windows of 1, 2, and 3 months. Repeated nonadherence was defined as three unfulfilled prescriptions within a 3-month expiration window. Multivariable Cox proportional hazards models were used to identify risk factors for repeated failure. Results: Among 40,200 treated patients, ≥80% cumulative prescription fulfillment was achieved in 80.3% of the population under a 3-month expiration definition. Under a strict 1-month definition, the incidence rate of the third compliance failure was 335 per 1000 person-years. In multivariable Cox analysis, obesity (HR 1.37, 95% CI 1.29–1.45) and current smoking (HR 1.07, 95% CI 1.04–1.11) were independently associated with increased risk of repeated failure. Older age (≥70 years: HR 0.73, 95% CI 0.62–0.87) and higher baseline intraocular pressure (≥25 mmHg: HR 0.65, 95% CI 0.61–0.68) were associated with reduced risk. Initiation with prostaglandin analogs was associated with lower hazard compared with alpha-2 adrenergic agonists (HR 0.53, 95% CI 0.49–0.57), whereas treatment alterations (≥3 changes) were associated with increased hazard (HR 1.64, 95% CI 1.39–1.95). Conclusions: Repeated nonadherence to topical glaucoma therapy is common and is associated with identifiable behavioral and treatment-related factors. Recognition of patients at elevated risk may support targeted strategies to enhance long-term treatment stability.

Background/Aims Reports have suggested that treatment with systemic β-adrenoceptor antagonists (β-blockers) may increase the risk of developing Parkinson’s disease (PD). The objective of this study was to assess the association between the use of topical β-blockers and PD. Methods A retrospective cohort study. All newly diagnosed glaucoma patients between 2000 and 2020 were recruited from the anonymised electronic medical records of a large healthcare provider. Patients were followed until December 2021 for the occurrence of PD. The patients were divided into two groups according to topical β-blocker use. Cox proportional-hazards models were used, and HRs with 95% CIs were calculated. Results The cohort included 13 381 glaucoma patients, of whom 10 075 used topical β-blockers (βB group) and 3306 did not (no-βB group). Demographic characteristics were similar between groups. Mean follow-up time and mean number of filled prescriptions for anti-glaucoma medication (total and annually) were significantly greater in the βB group (p<0.0001). During follow-up, 175 patients (1.31%) were diagnosed with PD, 145 in the βB group and 30 in the no-βB group. The HR for PD among topical β-blocker users compared with non-users was 1.16 (95% CI 0.78 to 1.72, p=0.47). Kaplan-Meier analysis showed no significant difference in PD-free survival between the groups (p=0.47). Conclusions Topical β-blocker use was not associated with an increased risk of PD. These findings suggest that topical β-blockers are a safe therapeutic option, even for patients at potential risk for PD.