Review of Cornea

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Poor Glaucoma Drop Technique

Good intentions, bad instillations.
By Cheryl G. Murphy, O.D., Contributing Editor


Nine out of 10 glaucoma patients are not administering their drops correctly, according to a study in the March issue of Journal of Glaucoma.

Researchers in India examined a side of patient non-compliance that sometimes is overlooked—the unintentional, improper dosing and instillation of meds. Raghav Gupta, M.D., and colleagues observed and evaluated 70 primary open-angle and primary angle-closure glaucoma patients, ages 35 to 70, who had been self-administering glaucoma meds for at least six months. Individuals suffering from arthritis, tremors and other impairments that might interfere with their ability to correctly instill drops in their eyes were excluded from the study.

The patients were asked to instill one drop from a bottle of artificial tears into one eye using the same technique as they do to instill their glaucoma meds at home. The number of drops they squeezed out of the bottle actually ranged from one to eight drops.

Additional results showed:

  • 31% of patients “missed the mark,” dropping the eye drops on their eyelids or cheeks.
  • 75% touched the tip of the bottle to their eye or periocular tissue.
  • Just 28% correctly closed their eyes after instilling the drops.
  • Just 5% occluded their puncta.

After analyzing these results, Dr. Gupta and colleagues concluded that a mere six of the 70 glaucoma patients tested “were able to correctly instill the eye drop (squeeze out one drop and instill it into the conjunctival sac without bottle tip contact).”

The researchers conceded that there may be limitations inherent in their study, such as behavior modifications that patients exhibit when they know they are being observed. Also, they were not sure if socioeconomic status and literacy of subjects could have influenced the results.

Glaucoma specialist Richard Madonna, M.A., O.D., associate professor at SUNY College of Optometry, agrees with the researchers’ emphasis on the importance of doctors proactively demonstrating and teaching the proper technique of eye drop instillation to their glaucoma patients.

“Patients need to be educated (on proper instillation techniques) and it is our job to provide that education, just as we provide education on the medication’s side effects or on the results of a visual field,” he says.

Dr. Madonna suggests utilizing technicians and staff who normally train patients on contact lens insertion and removal to carefully demonstrate proper drop instillation to glaucoma patients using artificial tears.

He advocates giving glaucoma patients a “pop quiz” on drop instillation at follow-up visits, as suggested in the study. “If patients are asked to demonstrate the technique, an opportunity for teaching may present itself if the patient is having a problem,” he says.

Gupta R, Patil B, Shah BM, et al. Evaluating eye drop instillation technique in glaucoma patients. J Glaucoma. 2012 Mar;21(3):189-92.

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