We conducted a secondary, real-world clinical assessment of a randomized controlled trial to determine how a glaucoma medication adherence intervention impacted the clinical outcomes of participants at 12 months post randomization. Participants included veterans at a VA eye clinic with medically treated glaucoma who reported poor adherence, and their companions if applicable. Methods: The treatment group received a glaucoma education session with drop administration instruction, and virtual

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... nders from a "smart bottle" (AdhereTech) for their eye drops. The control group received a general eye health class, and the smart bottle with the reminder function turned off. Medical chart extraction determined if participants in each group experienced visual field progression, additional glaucoma medications, or a recommendation for surgery or laser due to inadequate intraocular pressure (IOP) control over the 12 months following randomization. The main outcome measure was disease progression, defined as visual field progression or escalation of glaucoma therapy, in the 12 months following randomization. Results: Thirty-six vs. 32% of the intervention (n=100) vs. control (n=100) group, respectively experienced disease intensification. There was no difference between the intervention and control groups in terms of intensification, [Intervention vs. Control Group Odds Ratio: 1.20, 95% Confidence Interval: (0.67, 2.15)], including when age, race, and disease severity were accounted for in the logistic regression model. Those whose study dates included time during the COVID-19 pandemic were evenly distributed between groups. Conclusions: A multi-faceted intervention that improved medication adherence for glaucoma for 6 months did not affect the clinical outcomes measured at 12 months post randomization. Twelve months may not be long enough to see the clinical effect of this intervention or more than 6 months of intervention are needed.