For glaucoma patients who are lax in taking their medications on a regular schedule, a personalized glaucoma coach may help them improve their compliance by offering counseling on correct eye drop instillation techniques and ways to avoid bottle contamination, a study in Ophthalmology Glaucoma reports. 

The study was part of the Support, Educate, Empower (SEE) program from the University of Michigan and included patients with a diagnosis of glaucoma or ocular hypertension. Participants took one or more glaucoma medications, were aged 40 or older, spoke English, self-administered their eye drops and had an 80% or less glaucoma medication adherence rate based on electronic monitoring.

The coaching program increased glaucoma medication adherence by 21% among patients with poor self-reported adherence at baseline, says researcher Paula Anne Newman-Casey, MD.

“The SEE coaching program’s success lies in its multipronged approach to improving adherence, including personalized glaucoma education, motivational interviewing-based health coaching and reminder systems. Participants highlighted the importance of their relationship with the glaucoma coach in helping them improve their adherence,” she adds. 

Patients were first video recorded instilling their eye drops before the first SEE in-person coaching session, which included teaching proper eye drop instillation techniques using a motivational interviewing-based approach.

At the third and final in-person counseling session six months later, patients were again video recorded instilling their eye drops. Participants’ self-efficacy was assessed using the validated Eye Drop Technique Self-Efficacy Scale (EDTSES) survey at baseline and one month after the program was complete. A masked observer, who was unaware of the two time points, reviewed the pre- and post-intervention videos.

The study’s main outcome was change in participants’ eye drop instillation technique as measured by accuracy of an eye drop landing on the eye, ability to instill an eye drop on the first attempt and contamination of the bottle by contact with the ocular surface, eyelashes and skin.

The secondary outcome measure was the change in EDTSES (six items, each assessed on a three-point Likert scale, with higher scores indicating better self-efficacy).

A total of 39 subjects completed the SEE intervention, 38 with pre- and post- EDTSES scores and 31 with video recordings. The researchers reported six out of 31 participants who instilled drops outside the eye pre-intervention improved their technique after coaching, while two participants had worse outcomes. Participants who were coached also showed significant improvements in not touching the ocular surface, eyelashes or skin with the bottle tip. Investigators noted a significant increase in eye drop instillation self-efficacy from an average score of 2.6 to 2.8 on EDTSES.

Schneider KJ, Hollenhorst CN, Valicevic AN, et al. Impact of the support, educate, empower (SEE) personalized glaucoma coaching program pilot study on eye drop instillation technique and self-efficacy. Ophthalmology Glaucoma. August 8, 2020. [Epub ahead of print].