Randomized Clinical Trial Comparing Open versus Closed Eye-Drop Instillation Technique in Glaucoma Patients

Abstract

Purpose: : To compare the success rate of eyedrop instillation in glaucoma patients and suspects who chronically use eyedrops after training them in using either an open or closed eye instillation technique.

Methods: : Glaucoma patients and suspects from the glaucoma service at Hospital Sotero del Rio, Santiago, Chile were included in the study. Eligibility criteria included bilateral topical treatment for >=1 years and habitual correction visual acuity of 20/60 or better in at least one eye. Patients were randomly assigned to receive a structured educational session on how to instill eyedrops with either an open or closed eye technique. The session used a poster with images, each with a caption that was read to the patient by the study technician. The patient then attempted each step of the technique with an empty practice bottle while the technician provided feedback.After the training session, patients were asked to attempt instillation of a single drop of 0.25% fluorescein into each eye using the assigned technique. Data are reported for the first eye for each patient only, which was also randomly assigned. Patients were videotaped during the instillation process. Thirty seconds after completing instillation a Schirmer strip was carefully used to collect tear from the inferior cul-de-sac without touching the lashes or lid margin.Outcomes: Total success was defined as getting the drop in the eye using only one drop and qualified success was defined as getting the drop in the eye irrespective of the number of drops used.

Results: : One-hundred and fifty-three patients with a mean age of 72.3 years (SD=9.6) were enrolled. 60% were women and the average mean deviation was -11.2 dB (SD=9.5). Total success was achieved by 53.2% (42/79) and 23.0% (17/74) in the open and closed eye-drop instillation group respectively (X2 p-value<0.001). Qualified success was achieved by 86.7% (68/79) and 62.2% (46/74) in the open and closed instillation group respectively (X2 p-value<0.001). The average number of drops required was 1.86 (SD=1.50) vs 2.52 (SD=1.51) in the open and closed eye-drop instillation group respectively (Student's t-test p=0.007).

Conclusions: : The open eye instillation technique was superior to the closed eye technique and training to improve patient outcomes should focus on the open eye technique. Nearly twice as many drops were used than needed. Additional studies are planned to determine if ongoing training can improve the success rate and reduce the number of drops used.

Clinical Trial: : http://www.clinicaltrials.gov NCT01417689

Keywords: clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • drug toxicity/drug effects