Abstract
Purpose: :
To study the effect of instructions on improving the eye drop instillation technique in patients with primary adult onset glaucoma.
Methods: :
This cross-sectional observational study included 95 patients with primary open angle glaucoma (POAG) or primary angle closure glaucoma (PACG post laser iridotomy) using topical ocular hypotensive medications for more than 6 months. All patients were asked to instill a tear substitute (0.5% sodium carboxymethyl cellulose) in one eye, using the technique they used for administration of their topical anti- glaucoma medication at home. Any patient with best corrected visual acuity of less than 3/60 in the better eye, or significant systemic morbidity (e.g. rheumatoid arthritis, musculo-skeletal disorders, psychiatric illness etc), interfering with instillation of topical medication, were excluded from the study. The parameters recorded included: number of drops squeezed out from the bottle; whether patient touched the dropper tip to the globe or to periocular tissue and eyelid closure/ punctum occlusion after the administration of drops. All patients were then instructed and demonstrated the appropriate method of eye drop instillation which included instillation of a single drop in the inferior conjunctival fornix without touching the dropper tip to the peri-ocular tissue and closing the eye with punctual occlusion for 2 minutes. The above parameters were recorded again after 4 weeks.
Results: :
The mean age of the patients was 53.8 + 11.2 years (54 males, 41 females). Before and after instructions, the mean number of drops dispensed per treatment decreased from 2.5 + 0.9 to 1.6 + 0.5 (p < 0.0001). Forty nine (51.58%) patients touched the dropper tip to the globe or periocular tissue before instructions as compared to 34(35.79%) patients (p=0.04) after being taught the correct method. The number of patients who closed the eyelid or occluded the punctum for 2 minutes or more increased from 34 to 66 (p< 0.0001). Overall only 20 (21.05%) patients were able to correctly instill the eye drops before instructions, and this improved to 52 patients (54.74%) after instructions and demonstration (p<0.0001).
Conclusions: :
There was a significant improvement in eye drop instillation technique in glaucoma patients 4 weeks after instructions and demonstration of the correct technique. However, even after demonstration of the correct method, nearly half of the patients were still unable to instill eye drops correctly. This study underscores the importance of repeated instruction and evaluation of eye drop instillation technique in glaucoma patients on chronic ocular hypotensive therapy.
Keywords: learning • drug toxicity/drug effects • clinical (human) or epidemiologic studies: health care delivery/economics/manpower