The Challenge for Many Glaucoma Patients to Instill Eye Drops
It has long been considered a challenge for patients to properly instill eye drops. It is particularly difficult for many elderly glaucoma patients who require daily eye drops but have hand eye coordination issues. A recent study conducted at the University of Michigan, however, found the difficulty may be reduced if a number of repetitive exercises occur prior to drop instillation. The authors of the study, Madeline Kate Weber and Paula Newman-Casey, MD noted a previous study that reported about 33% of glaucoma patients have difficulty with successfully instilling their eye drops which highlights the need to investigate ways to improve success rate. (1)
According to Weber and Newman-Casey, “There is a gap in our understanding of the specific challenges glaucoma patients encounter when instilling eye drops, especially regarding sensorimotor factors such as hand function.” In order to address this problem, the investigators conducted a pilot study to assess eye drop instillation performance and hand function in glaucoma patients who instilled daily medicated eye drops. The results were then compared to healthy patients who did not use daily eye drops. The investigators considered location and the number of the dispensed eye drops and if there was contact between the bottle containing the drops and the ocular adnexa. Each participant in the study underwent 18 instillation trials. Tests were performed including function and dexterity using grip strength and pinch force, the grooved pegboard test and the arthritis hand function test.
Results of the Study
Twenty patients with glaucoma (mean age of 76.6) and 68 controls (mean age of 72.8) participated in the study. The analysis revealed that the proportion of successful drop instillations into the eye did not differ significantly between glaucoma patients and control group, except the glaucoma patients used fewer drops on average per trial. Interestingly, the results did not reveal any significant difference between the groups in the number of times the medication bottle touched the ocular adnexa.
There was, however, a significant difference with the glaucoma patients who displayed a weaker mean grip strength and pinch force. In addition, they required additional time to complete the grooved pegboard and arthritis hand function tests. The researchers commented that, “Our findings indicated that although glaucoma patients are likely to have motor deficits due to older age, through repetitive practice of daily eye drop application, patients can improve their technique and overcome these motor deficits. These data demonstrate the potential ability in an individualized approach to teaching eye drop instillation the first time medicated eye drops are prescribed.”
Implications
Even though the patients demonstrated worse hand function, they ultimately were able to overcome this deficit due to repetitive trials and subsequently instilling their eye drops. A reasonable conclusion to draw from this investigation is that an individualized approach to patients can improve the ability of patients to properly instill their eye drops.
- Hennessy AL, Katz J, Covert E. et al, A video study of drop instillation in both glaucoma and retina patients with visual impairment, AM J Ophthalmol. 2011
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