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Number of eye drop bottles associated with incorrect usage
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Glaucoma patients who were found to use eye drops incorrectly were often prescribed more bottles of eye drops than other patients, according to a study recently published in the Journal of Glaucoma.
Kawai-Tsuboi and colleagues assessed 67 glaucoma patients who were using topical antiglaucoma medications in order to identify an association between prescription patterns and medication usage.
Researchers compared the number of prescription bottles prescribed each month as well as data from a patient questionnaire. The questionnaire examined the patients' awareness of side effects, their accuracy in instilling the eye drops, how often they used the drops, how many drops they administered in each instillation and their administration method.
Results showed that the only factor associated with the number of prescribed eye drop bottles was incorrect administration. Researchers reported that glaucoma patients who put their drops outside of their eyes were prescribed more medication bottles.
"The current study demonstrated that patients with glaucoma who use eye drops incorrectly (such as misplacing the drops outside the eye during instillation) tend to receive more bottles of medication than patients who use eye drops correctly," the authors concluded. "Incorrect use of antiglaucoma eye drops can result in poor IOP control and unexpected local side effects."
They continued: "In addition, excessive use of antiglaucoma eye drops may contribute to an overall increased economic burden of glaucoma, because medication costs represent a high proportion of the total treatment costs of glaucoma. In the daily clinic, it is important for [eye care providers] to determine whether patients (especially those who use multiple medications) who request an unusual number of eye drops are using the eye drops correctly." – by Chelsea Frajerman
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Blair Lonsberry, OD, FAAO
Proper utilization of anti-glaucoma drops is a major obstacle to successful treatment of glaucoma. It is often challenging for the clinician to determine if a patient is being adherent to the prescribed treatment regimen.
In this study, the authors used a questionnaire to determine how patients use their glaucoma medications and also assessed the association between number of bottles prescribed and medication use.
The authors found that patients who had more than two medications, used more than two drops per application or had poor drop placement were prescribed more bottles. Additionally, men or patients with mild glaucoma were less likely to be aware of local side effects than women or patients with severe glaucoma.
The primary result of this study is intuitively obvious: patients who are poor at putting in their eye drops use more than the expected amount of drops and need more bottles than patients who are adept at instillation. Nevertheless, these results remind us that it is prudent to have patients demonstrate drop instillation during scheduled appointments to ensure proper technique. These skills should be re-emphasized on every follow-up appointment to improve adherence and IOP control.
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