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Niccolo Dosto, Harry A Quigley; Electronically Monitored Steroid Eyedrop Adherence After Trabeculectomy Compared to Surgical Success. Invest. Ophthalmol. Vis. Sci. 2020;61(7):964.
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© ARVO (1962-2015); The Authors (2016-present)
To measure adherence with steroid eyedrops after trabeculectomy electronically, comparing it to a standardized questionnaire and to the achievement of target IOP at 6 months and 1 year.
Participants were recruited one day after trabeculectomy surgery at the Wilmer Eye Institute. Patients were aware that the electronic bottle holder and charging base (Kali Care) monitored drop usage. The Kali Drop device records the time when the device is squeezed upside down, transmitting recordings via cellular data to a central server in real time. Patients were instructed in device use and prescribed 1% prednisolone acetate drops every 2 hours while awake for 1 week, 4 times daily for 1 week, then 3, 2, and 1 time per day each week until they stopped after 5 weeks post-op. Phone calls were made to patients after two days of inactivity, but only to check on the status of the device and not as a reminder. Criteria for appropriate separation between drops were applied for each frequency.
The first 9 subjects of a scheduled 100 to complete a 5-week eyedrop regimen had mean adherence with q2h drops of 75% (range: 37-93%) and with qid at 92% (range 64-110), which remained even higher at lower prescribed frequencies. Prediction of adherence by a questionnaire developed for daily IOP-lowering drops was poor; Pearson’s correlation values show a moderate negative correlation between average total adherence and predicted adherence (-0.41). Out of 36 total visits from 9 subjects, only 4 reported pain levels greater than 0 on a scale of 0-10. 3 out of 36 visits had anterior chamber cell counts of 1, and 1 visit had a cell count of 3, while the rest had no anterior chamber cells. There is also a moderate negative correlation between the number of prior surgeries and adherence (-.63), while there was a moderate positive correlation between adherence and field mean deviation (.61). The primary outcome, the achievement of target IOP compared to adherence, will be presented after the patients’ 6-month visits.
This will be the first study to our knowledge that compares electronically monitored eyedrop adherence to trabeculectomy success. Devices recording medication use in real time can be linked to electronic reminder systems, which have been proven to increase patient adherence to medication.
This is a 2020 ARVO Annual Meeting abstract.
Eyedrop use data for an individual subject (006) who had an average total adherence of 77%.
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