Abstract
Purpose :
It is established that treatment to lower intraocular pressure is effective in reducing risk of disease worsening in eyes with ocular hypertension and glaucoma. Few studies have examined efficacy of eye drop instillation in relation to longitudinal disease progression. We performed a retrospective observational cohort study to evaluate the association between efficacy of self-instillation of eye drops and long-term glaucoma outcomes.
Methods :
In 2011, a study was performed in which video recordings of eye drop self-instillation by patients were graded as Effective or Ineffective. Patients with primary open-angle, pseudoexfoliation, pigmentary, or uveitic glaucoma, or ocular hypertension, on topical ocular hypotensive therapy for at least 6 months, were included. Patients with disabilities that could interfere with eye drop instillation were excluded. Glaucomatous progression was defined as retinal nerve fiber layer (RNFL) thinning on OCT, worsening of field defects on Humphrey Visual Field (HVF) testing, or need for surgery, as determined by a glaucoma specialist unaware of patient performance in the eye drop instillation study.
Results :
The original study enrolled 119 patients, and 101 patients had sufficient follow-up (at least 2 OCT or HVF studies) and were included in final analysis. 88 patients (87.1%) were Effective in eye drop instillation. Mean follow-up was 5.1 years, during which time 74 patients (73.3%) had progression in either eye or underwent surgery. A significantly higher proportion of patients in the Ineffective group met criteria for progression or underwent surgery (Effective: 69.3%; Ineffective: 100%; N = 101; P = 0.018, Fisher’s exact test). Kaplan-Meier Survival analyses showed significantly faster time to RNFL progression, HVF progression, and/or surgery in the Ineffective group (N = 101; P = 0.015, Log-rank test). There was no difference in age, baseline IOP, or baseline RNFL thickness between the groups.
Conclusions :
Our study shows an association between baseline eye drop instillation efficacy and long-term progression of glaucoma. These findings suggest patients who are ineffective at instilling eye drops may be at increased risk for disease progression.
This is a 2020 ARVO Annual Meeting abstract.