Electronic compliance monitoring of topical treatment after ophthalmic surgery

Abstract

The success of many medical treatments is built on compliance. Electronic monitoring is the most accurate tool to quantify compliance by measuring adherence. In order to assess the efficiency of a recently introduced miniature monitoring device for eye drop application, we evaluated adherence in ophthalmic patients undergoing post-operative shortterm topical treatment. This pilot study enrolled 30 outpatients (mean age 61.8 ± 18.5 years) after cataract (n = 24) and glaucoma filtration surgery (n = 6) applying fixed-combination eye drops containing prednisolone and gentamicin five times daily for 2 weeks. Patients received eye drops in conventional bottles each equipped with a miniature monitoring device recording events of application. Two patients failed to bring back the monitoring device; therefore data collected from only 28 patients could be examined. Data showed highly variable results with a mean dose compliance of 50.2%. Dose compliance was below 25% in approximately one out of five patients. Four cataract patients, but no glaucoma patient, discontinued therapy prematurely. The observed mean dosage interval was calculated for each patient and ranged 4.6-19.7 h. Thirty percent of analysed dosage intervals exceeded 12.0 h. Different patterns of compliance behaviour-like early nonpersistence, drug holiday and low treatment frequency could be identified and illustrated using electronic data. Age or gender did not significantly influence compliance rates. Our pilot study demonstrates successful electronic compliance monitoring using a technology capable of continuous data recording over weeks of treatment. The low compliance rate for a relevant part of the patients demonstrates the necessity to study and improve compliance in ophthalmology. In future, new application methods and electronic application devices may improve treatment response in eye care.

Efficacy and Safety of Sustained Release Dexamethasone for the Treatment of Ocular Pain and Inflammation after Cataract Surgery: Results from Two Phase 3 Studies

“…Historically, compliance with dosing of topical ocular medications in eye drop form has been poor [14,15,36]. Patients, particularly the elderly, can find the complicated dosing regimens required with some topical ophthalmic medications to be challenging [14].…”

“…Patients, particularly the elderly, can find the complicated dosing regimens required with some topical ophthalmic medications to be challenging [14]. An electronic monitoring study in cataract surgery patients who were asked to dose steroid and antibiotic drops fives time daily for 2 weeks, found only about half were compliant with their medication dosing [36]. This noncompliance, combined with inaccurate drop administration problems discussed above, can put patients at risk for post-surgical complications.…”

Clinical outcomes after injection of a compounded pharmaceutical for prophylaxis after cataract surgery

“…Prescription eye drops can be expensive, and treatment regimens are often complex, sometimes including up to three medications, each requiring different numbers of drops at various intervals throughout the day for up to several weeks [1,8]. A compliance monitoring study found that cataract surgery patients only applied half of the prescribed number of postoperative drops [9]. A separate video-based analysis found that 93% of eye-drop naïve patients used improper technique when applying postoperative drops [10].…”

Drops, Drops, and More Drops

“…Conventional bottles of eye drops can be equipped with the recently developed Travatan Dosing Aid (Alcon Laboratories, Inc., Fort Worth, TX), a miniature monitoring device that records the time and day when the lever that administers the medication is depressed. (Hermann et al, 2010;Friedman et al, 2009;Okeke et al, 2009a) Different patterns of adherence behavior can be identified from the downloaded data, and it was accurate in 93% in patients. While the majority of patients found it made dispensing drops easier, it also contains a reminder that can help increase adherence.…”