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Many glaucoma patients have difficulty instilling eye drops
Ophthalmology. 2010;117(12):2345-2352.
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Glaucoma patients with impaired vision showed diminished ability to successfully self-administer IOP-lowering eye drops, a study found.
Unintended contact between the bottle and ocular surface was particularly problematic.
"We discovered through the survey that patients had a generally poor awareness of their inability to successfully instill a drop," the authors said.
The prospective study included 204 patients with ETDRS visual acuity of 20/60 or worse and severe visual field damage in one or both eyes. Mean patient age was 68.8 years.
Patients completed a survey on eye drop use and were videotaped instilling drops.
Overall, 71% of patients were able to administer drops. However, only 39% of patients were able to instill one drop without touching the ocular surface; those patients instilled a mean 1.4 drops in 1.2 attempts, according to the study.
Patients older than 70 years were 60% less likely to succeed than those younger than 70 years; the difference was statistically significant (P = .005).
Sixty-six patients (32%) touched the bottle tip to the ocular surface. The survey showed that of 142 patients who did not report touching their eyes, 24% were observed doing so.
"As clinicians, we owe it to our patients to offer better instruction, asking that a family member or friend get involved in instilling eye drops or designing new instillation devices," the study authors said.
This is the first study to systematically monitor the drop instillation techniques for self-administration of visually impaired patients. The study’s methodology and techniques were very simple, but highly effective. The low accuracy and waste observed must factor into the clinician’s therapeutic rationale for the care of patients with visual impairment. Clinicians should strongly consider inquiring of the patient who is administering their eye drops or if they are adequately educated and able to self-administer the drops. This will likely be considered a landmark study in the area of compliance.
– Douglas J. Rhee, MD
OSN Glaucoma Board
Member
Disclosure: Dr. Rhee is a consultant for Alcon, Allergan, Johnson
& Johnson and Santen.