Most patients have difficulty with proper eyedrop instillation
Click Here to Manage Email Alerts
Better patient instruction and education can help increase correct eyedrop instillation, which is affected by age, vision and upper limb mobility, according to a study published in the Journal of Glaucoma.
“Despite major innovations such as the widespread use of laser and minimally invasive surgery, topical treatments remain the recommended first-line treatment to reduce IOP,” Florent Aptel, MD, PhD, of the department of ophthalmology, Hôpital Michallon, Grenoble, and University of Grenoble Alpes, Saint-Martin-d’Hères, France, and colleagues. “Noncompliance to eyedrop instillation regimens is frequent, with consequences that can be serious, with a risk of progression of the disease and potentiation of adverse effects.”
The multicenter, randomized cross-sectional trial comprised 173 participants with unilateral or bilateral glaucoma or ocular hypertension (mean age, 75 years). Researchers administered two surveys to the participants: the Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) to assess limb mobility and the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) to assess “quality of life in relation to overall visual function.” After the survey, investigators asked patients to instill eyedrops from a single dose container and a multidose container in front of an observer.
The researchers’ goal was to compare the quality of instillation of eyedrops with single-dose or multidose containers in glaucoma patients and assess factors likely to affect instillation, particularly the upper limb mobility, according to the study.
In a multivariate analysis, researchers saw a significant association between inadequate single-dose instillation, old age (P = .021), severity of the visual field deficits (P = .035) and a low quality of life score (P = .028). But they did not see an association between the QuickDASH score and the quality of instillation.
The investigators concluded that “attention to patient instruction and practice may improve proper drop administration.”
Aptel and colleagues noted that limitations to their study included subjective responses to the questionnaires and not enough representation of patients with severe glaucoma or physical disabilities.
Perspective
Back to Top
Topical medications have long been the mainstay of glaucoma treatment. Despite the growing acceptance of laser trabeculoplasty and minimally invasive glaucoma surgery, eye drops are still the first line treatment for many practitioners. While their safety and efficacy are proven, there are significant barriers to effective medical therapy.
Aptel and colleagues have provided some unique insights into the challenges of topical treatment. Not surprisingly, they found only about one-third of patients are adept at instilling eye drops. Also, their results show that there was no difference in instillation quality between multi-dose and single dose containers. How do we apply these and other studies’ results to our practice?
The literature is replete with evidence that patients are poorly compliant with topical glaucoma medications. Perhaps this is due to poor dexterity or ocular side effects or just human laziness. The literature has convinced me that this is a significant issue. You, the glaucoma doctor, must identify and remove barriers for your individual patient. Question your patients, ask them to demonstrate their instillation technique, train and educate them and their family members. It is your job to provide effective glaucoma treatment, and topical medications are only effective if used properly.
Collapse
Aptel F, et al. J Glaucoma. 2021;doi:10.1097/IJG.0000000000001867.
Read more about
Click Here to Manage Email Alerts