Drop instillation and glaucoma

Abstract

Poor eye drop technique is a significant impediment to achieving good control of intraocular pressure in glaucoma. Both mechanical device interventions and educational interventions offer promise to improve patients' technique, but studies with stronger designs need to be done followed by introduction into clinical practice.

<p>Adherence with Medical Therapy for Primary Open-Angle Glaucoma in Kenya – A Pilot Study</p>

“…Davis et al reviewed the literature on drop instillation and found reports suggest 6.8-37.3% of patients miss the eye with the drop. 21 None-the-less our patients had a reduction in pressure implying the active ingredient was reaching their eye; at least on the days they were assessed.…”

<p>Clinical Evaluation of a Novel Electromechanical Topical Ocular Drug Delivery System: Two Phase 1 Proof of Concept Studies</p>

“…In patients with glaucoma and ocular hypertension, topical antihypertensive agents are typically the first-line therapy for controlling intraocular pressure. 1,11,16 Persistent elevation of intraocular pressure leads to optic nerve head damage and visual field loss; therefore, proper instillation and adherence to the prescribed therapeutic regimen are vitally important to prevent optic nerve damage and preserve vision. 1,[6][7][8] Prior studies have shown a significant correlation between both non-adherence and poor instillation technique and adverse clinical outcomes such as increased intraocular pressure and visual field loss.…”

“…1,11,16 Persistent elevation of intraocular pressure leads to optic nerve head damage and visual field loss; therefore, proper instillation and adherence to the prescribed therapeutic regimen are vitally important to prevent optic nerve damage and preserve vision. 1,[6][7][8] Prior studies have shown a significant correlation between both non-adherence and poor instillation technique and adverse clinical outcomes such as increased intraocular pressure and visual field loss. 8,12,14,22 Studies evaluating self-administration of eye drops in patients with glaucoma have shown that 11-60% are nonadherent to the prescribed therapy, 8,12,14,15,[23][24][25][26] 34-92% use improper instillation technique, 3,8,12-17 7-44% miss the eye completely, 3,12,15,16,27,28 and 18-80% contaminate the tip of the bottle by contacting the eye or periocular tissue.…”

“…Conventional dropper bottles require the patient to tilt their head backward, position the dropper directly over the eye without a reliable guidance system, and then deposit the prescribed number of drops on the surface of the eye-all without contacting the eye or eyelid with the tip of the dropper. 1,2 As a consequence, errors due to poor technique are common and range from missing the eye completely or delivering an excessive dose to contaminating the dropper bottle by contacting the eye or eyelid. 3,4 Additionally, physiologic factors such as an exaggerated blink reflex, lid spasm, and reflex tearing can prevent proper deposition and retention of the medication on the surface of the eye.…”

“…5 Proper administration and strict patient adherence to the prescribed therapeutic regimen are important to ensure safe and efficacious use of topical ocular therapies and to preserve vision in chronic conditions such as glaucoma, dry eye, and ocular inflammatory and infectious disease. 1,[6][7][8] Improper instillation techniques can lead to treatment failure, adverse events, and a potential risk of serious infectious complications. [9][10][11][12][13] Despite the importance of proper administration, studies evaluating instillation technique in glaucoma patients receiving topical antihypertensive therapy via a conventional eye dropper show that the proportion of patients using improper technique ranges from 34% to 92%.…”