title: Evaluation of eye drop administration technique in patients with glaucoma or ocular hypertension.
abstract: OBJECTIVE
  To evaluate eye drop administration by patients at multiple visits in the setting of a randomized controlled trial.
  
  
  METHODS
  Patients with glaucoma or ocular hypertension were randomized to 12 weeks of treatment with topical ocular hypotensive medication in a multicenter, investigator-masked trial. At baseline, patients were given a questionnaire for self-assessment of difficulty with drop administration. At baseline and 12 weeks, patients demonstrated drop instillation using a bottle of artificial tears.
  
  
  METHODS
  Patient self-assessment of difficulty with drop administration and observed patient difficulty with drop administration, defined as bottle touching eye/adnexa, drop missing the ocular surface, or administering more than 1 drop.
  
  
  RESULTS
  Of 164 enrolled patients, 50% had previously been treated with ocular hypotensive medication for ≥3 years. Only 11.4% of patients reported difficulty with eye drop administration at study entry. At baseline, 18.2% of patients touched their eye/adnexa with the bottle and 10.3% missed the eye. At 12 weeks, 18.5% and 8.6% of patients, respectively, had similar difficulties. Overall, difficulty with drop instillation was observed in 42.1% of patients. Difficulty at both visits was seen in 35.3% of patients who reported difficulty at entry and in 17.2% of patients who denied difficulty. The relative risk of demonstrating difficulty at either visit was 2.0 times greater for patients who self-reported difficulty at study entry (P = 0.004). The relative risk of demonstrating difficulty at week 12 was 3.8 times greater for patients with observed difficulty at baseline (P < 0.001). Limitations of the study design included self-administration of drops to the eye of the patient's choice and observation in an office setting.
  
  
  CONCLUSIONS
  Patients with experience instilling topical glaucoma medications continue to have difficulties with eye drop administration, including patients who do not self-report difficulty. The risk of difficulty with eye drop administration is increased in patients who self-report difficulty and in patients who have been previously observed to have difficulty.
  
  
  BACKGROUND
  NCT01253902.
authors.affiliation: Greater Baltimore Medical Center and Wilmer Eye Institute, Johns Hopkins University , Baltimore, MD , USA.
authors.forename: Gail F
authors.initials: GF
authors.lastname: Schwartz
authors.forename: David A
authors.initials: DA
authors.lastname: Hollander
authors.forename: Julia M
authors.initials: JM
authors.lastname: Williams
mesh_terms: D060433:Administration, Ophthalmic; D000368:Aged; D017028:Caregivers; D005260:Female; D005901:Glaucoma / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy*; D009883:Ophthalmic Solutions / Q000008:administration & dosage*; D012646:Self Administration; D012647:Self-Assessment; D011795:Surveys and Questionnaires
chemical_list: D009883:Ophthalmic Solutions