Comparison of success rates in eye drop instillation between sitting position and supine position

Abstract

PurposeTo compare the success rates of eye drop instillation in the sitting position and supine position among Japanese patients with ocular diseases (cataract, glaucoma, or retinal and vitreous diseases).MethodsPatients who were hospitalized in Okayama University Hospital for eye surgery were studied. Instillation procedures of each patient in both the sitting and supine positions were recorded using a video camera at the time of instillation. We defined “success” when one drop fell accurately onto the ocular surface at the first attempt. Instillation of two or more drops, drops delivered to a site other than the eye surface, and touching the eyelashes, eyelids, or conjunctiva with the tip of the eye drop bottle were regarded as “failure”. We excluded patients with vision below counting finger.ResultsOne-hundred and two patients (54 males and 58 females, aged 70.2 ± 12.3 years) with ocular disease who were hospitalized for surgery (cataract: 61.8%, glaucoma: 15.7%, retinal and vitreous diseases: 22.5%) were included in this prospective observational study. The mean duration of eye drop use was 3.1 ± 5.2 years. The success rate of eye drop instillation was significantly higher in the supine position than in the sitting position (64.7% vs. 50%, P = 0.0039). The mean age was significantly higher in the failure group than in the success group (74.0 ± 11.5 vs. 67.7 ± 12.4 years, P = 0.0085) for the sitting position, but not significantly different for the supine position (72.3 ± 12.9 vs. 70.1 ± 12.0 years, P = 0.3849). No significant differences in mean duration of drop use, mean corrected VA, and mean spherical equivalent refraction were observed between success and failure groups, for both sitting and supine positions.ConclusionsIn the present study, the success rate of eye drop instillation was significantly higher when applied in the supine position than in the sitting position.

Investigation of visual and physical factors associated with inadequate instillation of eyedrops among patients with glaucoma

“…The range of DASH among the currently enrolled patients was 0 to 48, which means that the disturbance of the upper extremities was not severe. Despite this enrollment limitation, DASH examination showed that instillation failure patients had significantly poor or impaired upper limb function, which is consistent with previous reports [ 8 , 11 ].…”

“…However, some patients may have difficulty bending their head much more than usual during eye drop instillation because of the decline in their physical performance due to aging. Another option is to adopt a supine position during instillation, as in Naito’s report [ 8 ].…”

“…Two PTs independently assessed whether patients instilled correctly, and the state of eyedrop instillation was recorded with a camera. According to previous reports [ 8 , 11 ], the definition of instillation failure satisfies any of the following: eyedrop instillation on the ocular adnexa region and not on the cul-desac directly; touching of the tip of the eyedrop bottle to the ocular surface, adnexa tissue, or eyelashes; and instilling two or more eyedrops in a single attempt. If the judgments by two PTs differed, the patients were required to complete additional trials until the judgments of the two PTs were the same.…”

“…Davis et al summarized rates of eyedrop instillation failure as follows: between 18.2 and 80% of patients contaminate their eyedrop bottle by touching their eye or face, 11.3-60.6% instill more than one drop, and 6.8-37.3% miss the eye when attempting to instill a drop [7]. Many factors are reported to be related to instillation failure: older age, insufficient instruction on the eyedrop instillation technique, female sex, arthritis, inadequate posterior bending of the head, much more severe visual-field defects, lack of positive reinforcement to take eyedrops, lower educational level, low self-efficacy, shape and hardness of eyedropper bottles, drug viscosity, and being seen at a clinic rather than a private practice [7][8][9][10][11][12]. However, previous results were not consistent.…”

One-Year Efficacy and Safety Assessment of Ripasudil, a Rho Kinase Inhibitor, in an Addition to or Replacing Existing Treatment Regimens: A Retrospective Study

“…[36][37][38] Patient's age was significantly higher in the (e) Addition-Poor IOP dropout than (a) Addition-Survival group (Table 4). Low compliance with eye drops is age-dependent 39,40 and could have influenced poor IOP control in this study (Table 4). IOP before ripasudil administration in (e) Addition-Poor IOP dropout was significantly higher than (a) Addition-Survival (Table 4).…”