Association of the Effectiveness of Eye Drop Self-instillation and Glaucoma Progression

Abstract

Among patients with glaucoma or ocular hypertension, ineffective self-instillation of eye drops was associated with an increased long-term risk of progression or advancement of treatment to incisional surgery. Purpose:The purpose of this study was to evaluate the association between the efficacy of self-instillation of eye drops and long-term glaucoma outcomes.Methods: In a previous study, video recordings of eye drop self-instillation by patients with glaucoma or ocular hypertension were graded as effective or ineffective depending on whether the patient successfully instilled at least 1 drop on the right ocular surface. Glaucomatous progression was then retrospectively defined as retinal nerve fiber layer thinning as measured by either optical coherence tomography, visual field progression, or need for incisional glaucoma surgery as determined by a glaucoma specialist unaware of patient performance in the eye drop instillation study. Subjects with at least 2 follow-up optical coherence tomography or visual field studies were included in the current study.Results: The original study enrolled 119 patients. Sufficient follow-up data were available for 101 patients. Eighty-eight patients (87.1%) were effective in eye drop instillation at baseline. Mean follow-up was 5.1 years, during which time 73 patients (72.3%) had progression or underwent incisional surgery in either eye. A significantly higher proportion of patients in the ineffective group met the criteria for progression or underwent incisional surgery (effective: 68.2%; ineffective: 100%; N = 101; P = 0.017, Fisher exact test). Kaplan-Meier survival analyses showed a significantly faster time to reaching an endpoint in the ineffective group (N = 101; P = 0.012, log-rank test). There was no difference in age, baseline intraocular pressure, or baseline retinal nerve fiber layer thickness between the groups. Conclusion:Ineffective self-installation of eye drops was associated with an increased risk of glaucoma progression or treatment advancement to incisional surgery.

Association of Health Literacy and Health Care Utilization Among Glaucoma Patients

“…However, taken together with the findings of increased polypharmacy and utilization across multiple classes of intraocular hypotensive medications, this could reflect more severe or recalcitrant disease in these patients, necessitating more intensive medical therapy. Alternatively, patients with LHL may not use their medications optimally because of poor adherence and poor eye drop administration technique,4 leading to an increased risk of disease progression and more refills 10,11. It may also be that patients with LHL are overtreated, possibly because of the expectation that these patients may not consistently follow-up.…”

“…Alternatively, patients with LHL may not use their medications optimally because of poor adherence and poor eye drop administration technique, 4 leading to an increased risk of disease progression and more refills. 10,11 It may also be that patients with LHL are overtreated, possibly because of the expectation that these patients may not consistently follow-up. Previous research found Black and Hispanic persons are more likely to have LHL, compared with non-Hispanic White individuals.…”

Identifying and addressing common contributors to nonadherence with ophthalmic medical therapy

“…Patients cannot be relied upon to report dosing problems, as there is a significant mismatch between patients’ belief in their skills and their actual skills [63,65,66], and among those who experience difficulty with self-dosing 26% would not ask for help [67 ▪▪ ]. Poor instillation technique has been linked to an increased risk of progression in glaucoma patients [68 ▪▪ ].…”

Travoprost Intracameral Implant for Open-Angle Glaucoma or Ocular Hypertension: 12-Month Results of a Randomized, Double-Masked Trial

“…However, the typically asymptomatic and chronic nature of the disease, complex dosing regimens, difficulty with instillation, lack of belief in the necessity of treatment, and chronic side effects associated with topical glaucoma medications undermine patient adherence and quality of life [ 1 – 5 ]. Although non-adherence to glaucoma therapy is known to contribute to the progression of glaucoma [ 6 – 8 ], nearly half of patients with glaucoma discontinue therapy within 6 months [ 9 ].…”