An Objective Evaluation of Eyedrop Instillation in Patients With Glaucoma

Abstract

To evaluate the performance of patients with ocular hypertension and glaucoma who are experienced in the instillation of topical ocular hypotensive medications.Methods: We conducted a prospective, open-label study at a single private practice site. We enrolled 139 patients with a diagnosis of glaucoma or ocular hypertension who used 1 or more topical ocular hypotensive medications for at least 6 months and who instilled their own medications. Patients were questioned regarding their use of topical ocular hypotensive medications, and we used a video recording to evaluate patient performance of eyedrop instillation with 2 bottle designs.Results: Patients reported relatively good performance on eyedrop instillation. One hundred twenty-nine of 139 patients (92.8%) reported no problem putting in their eyedrops, and 86 of 139 (61.9%) believed that they never missed their eye when administering the drops. The proportions of patients who were able to instill a single drop into the eye without touching the bottle to the eye were 14 of 64 (21.9%) with a 15-mL bottle and 36 of 117 (30.8%) with a 2.5-mL bottle.Conclusions: Under a single direct observation, patients experienced in the use of topical ocular hypotensive agents performed relatively poorly when instilling a single eyedrop into the eye without touching the bottle tip to the eye or the ocular adnexae.

The effect of the Thai “Eye Drop Guide” on success rate of eye drop self-instillation by glaucoma patients

“…Previous studies that video-recorded the performance of experienced glaucoma patients, evaluated their usual instillation technique. They have reported a success rate of 31% and 39% with the 2.5 ml and 5 ml bottle respectively [5][6][7][8][9][10][11][12][13][14]. Using the same triple criteria of success, the success rate of patient's usual technique of 41% in our study was consistent with previous studies.…”

“…Older age and more education were found to be a predictor of failure with the EDG. Older age and female sex was found to be associated with failure of eye drop instillation in previous studies [5,14,15]. By contrast, different results associated with educational level was observed in a multicenter study [3].…”

“…The sample size was calculated based on success rates of eye drop self-instillation; 33.8%-80% in previous studies [3][4][5][6][7][8]. We estimated success rates of the traditional technique and the EDG to be 60% and 80% respectively.…”

“…For eye drops, noncompliance can be in the form of failure to take medication, improper timing of medication, taking the wrong medication, or taking excessive medication, in addition to improper techniques of administration. The common mistakes in eye drop administration observed in glaucoma patients includes an inability to instill a drop into the eye, instilling more than one drop, and touching the bottle tip to the eye or periocular tissues [3][4][5][6][7][8]. Incorrect techniques may increase health care costs and harm the eyes, e.g.…”

Eye drop instillation technique in patients with glaucoma

“…In other studies, the incidence of missing the eye when attempting to instil an eye drop has ranged from 6.8 to almost 20%, and the incidence of contaminating the bottle tip has ranged from 20 to over 70%. 14,21 Factors associated with poor technique have also been examined with older age, 15 limited school education, 15,16 and poor vision 16 reported to be of importance. Brown et al 13 found that patients attending private practice were more likely to have a good eye drop instillation technique and suggested that this was because the private patients received better instructions on the use of drops; however, the effect of education on instillation technique was not directly examined.…”