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J. L. Stone, A. L. Robin, B. Sleath, D. W. Covert, G. Cagle, G. D. Novack; Compliance: An Objective Evaluation in Glaucoma Patients of Eye-Drop Instillation Using Video Observations and Patient Surveys. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1580.
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Patient compliance with glaucoma medications requires not only remembering to take an eye drop, but also placing the drop on the eye. This study investigates both patients’ perceptions of their eye drop instillation and actual eye-drop delivery.
We evaluated 140 consecutive glaucoma patients, who first completed a brief questionnaire regarding their drop delivery. We video-recorded patients instilling artificial tears from either low density polyethylene bottles, Boston round bottles, or both.
Subjects ranged in age from 21-94 yrs. (mean 67.5 +/-13.5 yrs.), 55% were female and 69% Caucasian. 95% (134/140) had been treated more than one year. Subjects perceived a high level of success with self-instillation according to their survey responses. 93% (130/140) reported no trouble instilling drops, and 51% (72/140) reported never missing their eye during delivery. Our review of the videos revealed only 83% (116/140) of patients accurately administered to the eye, 51% (72/140) were able to use the bottle without contamination, and 44% (62/140) were able to squeeze 1 drop from the bottle. Only 29% (40/140) of subjects achieved successful instillations, which were required to meet all three criteria. 39% (55/140) of subjects reported receiving prior instruction on appropriate instillation technique.
In this study population, objective patient performance during self-instillation of eye drops was much worse than perceived by patients. Assuming our in-office observations are no worse than in-home instillation by patients, we interpret low performance success of only 29%. We recommend eye care providers evaluate patient self-instillation performance. Further studies are required to evaluate the role of patient education in their performance.
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