Evaluation of eye drop administration technique in patients with glaucoma or ocular hypertension

Abstract

Objective:

To evaluate eye drop administration by patients at multiple visits in the setting of a randomized controlled trial.

Study design and methods:

Patients with glaucoma or ocular hypertension were randomized to 12 weeks of treatment with topical ocular hypotensive medication in a multicenter, investigator-masked trial. At baseline, patients were given a questionnaire for self-assessment of difficulty with drop administration. At baseline and 12 weeks, patients demonstrated drop instillation using a bottle of artificial tears.

Main outcome measures:

Patient self-assessment of difficulty with drop administration and observed patient difficulty with drop administration, defined as bottle touching eye/adnexa, drop missing the ocular surface, or administering more than 1 drop.

Results:

Of 164 enrolled patients, 50% had previously been treated with ocular hypotensive medication for ≥3 years. Only 11.4% of patients reported difficulty with eye drop administration at study entry. At baseline, 18.2% of patients touched their eye/adnexa with the bottle and 10.3% missed the eye. At 12 weeks, 18.5% and 8.6% of patients, respectively, had similar difficulties. Overall, difficulty with drop instillation was observed in 42.1% of patients. Difficulty at both visits was seen in 35.3% of patients who reported difficulty at entry and in 17.2% of patients who denied difficulty. The relative risk of demonstrating difficulty at either visit was 2.0 times greater for patients who self-reported difficulty at study entry (P = 0.004). The relative risk of demonstrating difficulty at week 12 was 3.8 times greater for patients with observed difficulty at baseline (P < 0.001). Limitations of the study design included self-administration of drops to the eye of the patient’s choice and observation in an office setting.

Conclusions:

Patients with experience instilling topical glaucoma medications continue to have difficulties with eye drop administration, including patients who do not self-report difficulty. The risk of difficulty with eye drop administration is increased in patients who self-report difficulty and in patients who have been previously observed to have difficulty.

Clinical trial registry number:

NCT01253902.

Keywords::

• Adherence
• Compliance
• Eyedrops
• Glaucoma
• Ocular hypertension
• Ophthalmic solutions

Transparency

Declaration of funding

This study was sponsored by Allergan Inc., Irvine, CA, USA.

Declaration of financial/other relationships

G.F.S. is a consultant to Allergan Inc. D.A.H. and J.M.W. are employees of Allergan Inc.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

Medical writing assistance was provided by Diann Glickman PharmD and Kate Ivins PhD of Evidence Scientific Solutions Inc. and funded by Allergan Inc.

The authors thank the principal investigators and their sites: Jason Bacharach (Petaluma, California, USA), Navaneet Borisuth (Rock Island, Illinois, USA), Andrew Cottingham (San Antonio, Texas, USA), Andrew Crichton (Calgary, Alberta, Canada), El-Roy Dixon (Albany, Georgia, USA), Baseer Khan (Vaughan, Ontario, Canada), Samuel N. Markowitz (Toronto, Ontario, Canada), Blythe Monheit (Austin, Texas, USA), Donald Nixon (Barrie, Ontario, Canada), Roberto Piemontesi (Nanaimo, British Colombia, Canada), William Rand (Deerfield Beach, Florida, USA), Steven Rauchman (Mission Hills, California, USA), Gail Schwartz (Baltimore, Maryland, USA), Steven Vold (Rogers, Arkansas, USA), Fiaz Zaman (Houston, Texas, USA).

Previous presentations: These results were presented in part at the 2012 Joint Meeting of the AAO and APAO, 10–13 November 2012, Chicago, IL, USA; and at the American Glaucoma Society 23rd Annual Meeting, 28 February–3 March 2013, San Francisco, CA, USA.