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

Abstract

Purpose The aim of this study was to investigate the frequency of eyedrop instillation failure and its related physical and visual function factors among glaucoma patients who used hypotensive eyedrops daily. Subjects and methods Patients with a history of self-instillation of one or more ocular hypotensive ophthalmic solutions for six or more months were enrolled. Definitions of instillation failure were eyedrop instillation other than on the eye surface; eyedrop contact with eyelashes; eyedrop bottle tip contact with the eyelashes, eye surface or ocular adnexa; or two or more drops instilled with one instillation trial. To clarify factors related to instillation failure, we used visual function tests and investigated cervical spine extension angles during instillation, pinching strength, physical ataxia (evaluated using the Scale for the Assessment and Rating of Ataxia), motor dysfunction of the upper limbs (evaluated using the Disabilities of the Arm, Shoulder and Hand questionnaire), and vision quality (evaluated using the National Eye Institute Visual Function Questionnaire 25). Results Of 103 total subjects, 61.2% satisfied the definition of instillation failure. Instillation of the eyedrop other than at the cul-desac (76.2%) was the most frequent reason for failure, followed by contact of the tip of the eyedrop bottle (22.2%) and instillation of the same or more than two eyedrops in a single attempt (11.1%). Advanced age, a shallow cervical spine extension angle, weak pinching strength, poor motor dysfunction of the upper limbs, the degree of ataxia, poor best-corrected visual acuity, and visual field scores were significant risk factors for instillation failure. Vision quality may have some relation to instillation failure. Conclusion It is highly recommended that instillation failure be routinely investigated even among patients with adequate experience using eyedrops and that correct therapies are chosen in a patient-based fashion.

Identifying and addressing common contributors to nonadherence with ophthalmic medical therapy

“…These concomitant tasks require a level of dexterity and coordination that may be challenging to many patients, particularly those with glaucoma who tend to be older. When patients are observed instilling their topical ophthalmic medications, up to 91% demonstrate one or more shortcomings resulting in dosing failure [59,60,61 ▪ ,62,63]. Too often, however, topical medications are prescribed with the expectation that patients will figure out on their own how to properly instill them.…”

“…Common problems that patients encounter when attempting to instill topical ophthalmic medications are characterized in Table 2. In studies of patients with various ocular conditions treated with topical medical therapy, up to 76% miss the eye entirely when dosing [60,61 ▪ ,64,66], and a similar proportion make unintended contact between the dropper tip and the eyelid or ocular surface, potentially injuring the eye [69] and contaminating the medication [59,60,61 ▪ ,62,64,66,70,71]. Contamination was more common in patients with weak handgrip strength [72].…”

“…Nearly half (49%) struggle to accurately aim the drop into the eye [73]. Some patients (20%) have difficulty squeezing the medication bottles [73], and many (11–64%) dispense more than one drop at a time [60,61 ▪ ,71]. This latter issue has additional undesirable consequences.…”

“…Arthritis of the hand is an established risk factor for both poor drop instillation technique [25,26] and poor adherence to glaucoma medications [77]. Additionally, functional impairments such as weak pinching strength and poor upper limb motor function are risk factors for instillation failure [61 ▪ ]. Osteoarthritis is a heterogeneous disease affecting multiple joints with frequent hand involvement.…”

Early Real-World Patient and Staff Experience with an Intracanalicular Dexamethasone Insert

“…5 Further, patients may not be experienced with eye drop instillation, with up to 91% of patients making one or more errors dosing their eyedrops, including 10-76% who miss the eye entirely. [5][6][7][8] Stone and coworkers found 27%-35% of patients dispensed at least 5 eye drops before one successfully got into the eye, and 17%-25% of patients could not place a drop into their eye despite many attempts, with many of these patients unaware that they were unsuccessful. 9 Self-administration of topical eye drops will likely magnify the issue with incorrect instillation in patients with comorbid conditions.…”