Subjective and objective assessment of the eye drop instillation technique: A hospital-based cross-sectional study

Abstract

Purpose: To objectively and subjectively evaluate eye drop technique and assess communicated instructions, and reported problems with eye drop instillation among tertiary care sample eye drop users. Methods: A cross-sectional, observational study was carried out among patients attending our outpatient clinic from June to September 2020. Eligible participants obtained through convenient sampling were assessed for their eye drop instillation performance. The objective evaluation was made using observation of a demonstration and subjective assessment through responses to an interview. Patient inclusion criteria were being aged ≥18 years and using eye drops for ≥ one month; excluded if having a disability in communication or physical barriers in using eye drops. The patient reported difficulties and previous education about the instillation were also obtained. Results: Participants ( n = 84) had a mean age of 50.3 ± 14.0 years. During the demonstration, almost everyone (86.9%) successfully instilled at least one drop in the eye. None of the participants exhibited a perfect drop technique. The most common deviations were failing to close the eye (60.7%), touching the bottle to the eye or eyelid (36.9% of patients), and multiple blinks after drop instillation without nasolacrimal occlusion (25.0%). Forty percent of patients reported ≥1 problem and only a small sample recalled having had education in the eye drop instillation technique. Conclusion: Most participants failed to properly execute the eye drop technique. A proactive role of the prescribing practitioner to assess a patient’s ability to instill eye drops correctly could be helpful.

The Application of Telemedicine Among Self-administered Eye Drop Users: the Accuracy and Patient Satisfaction

“…This showed similar attributes that other studies have noted to be important with regard to proper technique when administering eye drops (9,11,16,17). The least scored items were recorded in "P7-only a single drop instilled" (56%), "P9-nasolacrimal occlusion after unsuccessful instillation" (72%), and "P8-two drops or less used in total" (78%); all of these findings were consistent with previous research conducted in a real-world population of eye drop users and in tertiary care clinics (17,18).…”

Identifying and addressing common contributors to nonadherence with ophthalmic medical therapy

“…Eyelid closure after instillation is recommended to prevent excessive blinking that can wash away topical medication and reduce bioavailability; yet 61% of patients fail to close their eyes after instillation, and 25% demonstrate excessive blinking that may diminish drug effectiveness [59]. These problems can be compounded, as 40% of patients exhibited two or more issues with self-dosing [59]. Relevant to the COVID-19 pandemic era, 23-78% of patients failed to wash their hands before instilling their eye drops [16,59].…”

“…These problems can be compounded, as 40% of patients exhibited two or more issues with self-dosing [59]. Relevant to the COVID-19 pandemic era, 23-78% of patients failed to wash their hands before instilling their eye drops [16,59]. Overall, old age, advanced glaucoma, and poor quality of life were predictors of failure to correctly administer eye drop medications [76].…”

“…Too often, however, topical medications are prescribed with the expectation that patients will figure out on their own how to properly instill them. Up to 81% of patients using topical medications have no recollection of ever having been taught how to properly use them [64], and among patients who did receive instruction, a demonstration of proper technique was included only one-third of the time [59]. 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 ▪▪ ].…”

“…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].…”