title: Ability of Bottle Cap Color to Facilitate Accurate Patient-Physician Communication Regarding Medication Identity in Patients with Glaucoma.
abstract: OBJECTIVE
  To determine the accuracy of patient-physician communication regarding topical ophthalmic medication use based on bottle cap color, particularly among individuals who may have acquired color vision deficiency from glaucoma.
  
  
  METHODS
  Cross-sectional, clinical study.
  
  
  METHODS
  Patients aged ≥18 years with primary open-angle, primary angle-closure, pseudoexfoliation, or pigment dispersion glaucoma, bilateral visual acuity of ≥20/400, and no concurrent conditions that may affect color vision.
  
  
  METHODS
  A total of 100 patients provided color descriptions of 11 distinct medication bottle caps. Color descriptors were then presented to 3 physicians. Physicians matched each color descriptor to the medication they thought the descriptor was describing.
  
  
  METHODS
  Frequency of patient-physician agreement, occurring when all 3 physicians accurately matched the color descriptor to the correct medication. Multivariate regression models evaluated whether patient-physician agreement decreased with degree of better-eye visual field (VF) damage, color descriptor heterogeneity, or color vision deficiency, as determined by the Hardy-Rand-Rittler (HRR) score and Lanthony D15 color confusion index (D15 CCI).
  
  
  RESULTS
  Subjects had a mean age of 69 (±11) years, with VF mean deviation of -4.7 (±6.0) and -10.9 (±8.4) decibels (dB) in the better- and worse-seeing eyes, respectively. Patients produced 102 unique color descriptors to describe the colors of the 11 bottle caps. Among individual patients, the mean number of medications demonstrating agreement was 6.1/11 (55.5%). Agreement was less than 15% for 4 medications (prednisolone acetate [generic], betaxolol HCl [Betoptic; Alcon Laboratories Inc., Fort Worth, TX], brinzolamide/brimonidine [Simbrinza; Alcon Laboratories Inc.], and latanoprost [Xalatan; Pfizer, Inc., New York, NY]). Lower HRR scores and higher D15 CCI (both indicating worse color vision) were associated with greater VF damage (P < 0.001). Extent of color vision deficiency and color descriptor heterogeneity significantly predicted agreement in multivariate models (odds of agreement = 0.90 per 1 point decrement in HRR score, P < 0.001; odds of agreement = 0.30 for medications exhibiting high heterogeneity [≥11 descriptors], P = 0.007).
  
  
  CONCLUSIONS
  Physician understanding of patient medication use based solely on bottle cap color is frequently incorrect, particularly in patients with glaucoma who may have color vision deficiency. Errors based on communication using bottle cap color alone may be common and could lead to confusion and harm.
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Pujan
authors.initials: P
authors.lastname: Dave
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Villarreal
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: David S
authors.initials: DS
authors.lastname: Friedman
authors.affiliation: Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Malik Y
authors.initials: MY
authors.lastname: Kahook
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland. Electronic address: pramulu1@jhmi.edu.
authors.forename: Pradeep Y
authors.initials: PY
authors.lastname: Ramulu
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D003116:Color; D003119:Color Perception Tests; D003142:Communication; D003430:Cross-Sectional Studies; D004349:Drug Packaging / Q000592:standards*; D004363:Drug Utilization; D005260:Female; D005901:Glaucoma / Q000188:drug therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D055118:Medication Adherence; D008508:Medication Errors / Q000517:prevention & control; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D014792:Visual Acuity
chemical_list: D000959:Antihypertensive Agents; D009883:Ophthalmic Solutions