Electronically Monitored Corticosteroid Eye Drop Adherence after Trabeculectomy Compared to Surgical Success

The effect of cataract surgery on lowering intraocular pressure

PURPOSE OF REVIEW

To review the literature evaluating the effectiveness of cataract surgery alone and cataract surgery in combination with other procedures and surgeries on intraocular pressure (IOP) in patients with ocular hypertension and glaucoma.

RECENT FINDINGS

Recent studies of large trials have shown the IOP-lowering effect of cataract surgery and the beneficial effect of minimally invasive glaucoma surgery (MIGS). More studies are being published on when to use cataract surgery alone, with MIGS, or with traditional glaucoma surgeries for both primary open angle glaucoma and primary angle closure glaucoma.

SUMMARY

Patients with ocular hypertension and visually significant cataracts would benefit from cataract surgery alone to lower intraocular pressure. Patients with mild to moderate glaucoma would likely benefit from cataract surgery and MIGS to achieve a lower IOP. Patients with more advanced glaucoma would benefit from cataract surgery combined with a traditional incisional glaucoma surgery. Clear lens extraction can be used in patients with primary angle closure and early primary angle closure glaucoma. In patients with more advanced disease, phacoemulsification and another glaucoma surgery is likely to be required to achieve IOP control. MIGS are starting to be used in angle closure glaucoma, although more research needs to be done to define its role.

Analysis of Legal Verbiage in State Legislation for Insurer Coverage of Early Eyedrop Refills in the United States

PURPOSE

State laws on early eyedrop refills, implemented to help patients obtain their medications when they run out early, have many inconsistencies possibly impacting their efficacy and functionality. This study sought to examine different state laws and elucidate unique features and commonalities that may influence their effectiveness.

DESIGN

A review of all state legislation to date regarding early eyedrop refills was performed.

PARTICIPANTS

All 50 states were included, with an in-depth review of the 33 states that had early eyedrop refill legislation.

METHODS

The law database Nexis Uni (formerly LexisNexis) and each state's individual law code site were used to identify relevant laws (or proposed legislation) using keywords such as "eyedrop," "eye," "refill," and "early." Political data based on the year these laws were passed were obtained from the National Governor's Association and National Conference of State Legislatures. These data were aggregated and analyzed using descriptive statistics.

MAIN OUTCOME MEASURES

State law wording was analyzed for percentage of dosage period passed, days passed, and other requirements.

RESULTS

Of the 33 states with early eyedrop refill laws, 14 were only days based, 8 were only percentage based, 4 had both, 4 had neither percentage nor days criteria, and 3 had neither but cited Centers for Medicare and Medicaid Services guidelines. These laws were passed between 2009 and 2023, with a notable increase from 2014 to 2018, rising from 10 to 29 states. Regionally, the Northeast had the highest adoption rate (88%), followed by the West (77%), the South (56%), and the Midwest (50%). Political climates varied: 14 states had Republican control, 2 had Democratic control, and 17 had mixed party control. Of the 17 states without an early eyedrop refill law 4 attempted passage but were not put into law for various reasons with the other 13 not appearing to have had any attempts at law passage.

CONCLUSIONS

State laws providing coverage for early eyedrop refills vary in terms of verbiage and requirements necessary to obtain a covered early eyedrop refill. Region, political climate, and year appear to play minor roles in early eyedrop refill verbiage and passage.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A Comparative Preclinical Evaluation of a Novel Difluprednate 0.04% BID Ophthalmic Solution and Marketed 0.05% QID Ophthalmic Emulsion

Purpose: The purpose of this study was to compare the efficacy, and ocular pharmacokinetics of a new 0.04% w/v bis in die means twice a day (BID) ophthalmic solution and marketed 0.05% w/v quater in die means four times a day (QID) ophthalmic emulsion of difluprednate in New Zealand white (NZW) rabbits. Methods: The preclinical proof of concept was established in paracentesis-induced acute inflammation, endotoxin-induced acute uveitis, and bovine serum albumin-induced chronic uveitis in NZW rabbit animal models. A comparison of clinical score, total cell count, and total protein was performed to determine efficacy. An ocular pharmacokinetic study was conducted to study the influence of the vehicle on the ocular absorption of the drug. Results: In both uveitis models, the new solution formulation and marketed emulsion formulation inhibited total clinical score, total cell count, PGE2, and total protein significantly more than the placebo and lipopolysaccharide (disease control) groups and were comparable. In an ocular pharmacokinetic study, the Cmax and AUC0-t of difluoroprednisolone 17-butyrate in humor were ∼2-fold higher after 14 days' instillation of new solution formulation (0.04% w/v, BID) compared with 14 days' instillation of marketed emulsion (0.05% w/v, QID). Conclusions: The study demonstrated that the efficacy of the solution formulation at a lower dose and reduced dosing regimen were comparable to that of the emulsion formulation. The reduction in strength and regimen may result in improved patient adherence and outcomes.

Key Features of Smart Medication Adherence Products: Updated Scoping Review

BACKGROUND

Older adults often face challenges in self-managing their medication owing to physical and cognitive limitations, complex medication regimens, and packaging of medications. Emerging smart medication dispensing and adherence products (SMAPs) offer the options of automated dispensing, tracking medication intake in real time, and reminders and notifications. A 2021 review identified 51 SMAPs owing to the rapid influx of digital technology; an update to this review is required.

OBJECTIVE

This review aims to identify new products and summarize and compare the key features of SMAPs.

METHODS

Gray and published literature and videos were searched using Google, YouTube, PubMed, Embase, and Scopus. The first 10 pages of Google and the first 100 results of YouTube were screened using 4 and 5 keyword searches, respectively. SMAPs were included if they were able to store and allowed for the dispensation of medications, tracked real-time medication intake data, and could automatically analyze data. Products were excluded if they were stand-alone software applications, not marketed in English, not for in-home use, or only used in clinical trials. In total, 5 researchers independently screened and extracted the data.

RESULTS

This review identified 114 SMAPs, including 80 (70.2%) marketed and 34 (29.8%) prototypes, grouped into 15 types. Among the marketed products, 68% (54/80) were available for consumer purchase. Of these products, 26% (14/54) were available worldwide and 78% (42/54) were available in North America. There was variability in the hardware, software, data collection and management features, and cost of the products. Examples of hardware features include battery life, medication storage capacity, availability of types and number of alarms, locking features, and additional technology required for use of the product, whereas software features included reminder and notification capabilities and availability of manufacturer support. Data capture methods included the availability of sensors to record the use of the product and data-syncing capabilities with cloud storage with short-range communications. Data were accessible to users via mobile apps or web-based portals. Some SMAPs provided data security assurance with secure log-ins (use of personal identification numbers or facial recognition), whereas other SMAPs provided data through registered email addresses. Although some SMAPs were available at set prices or free of cost to end users, the cost of other products varied based on availability, shipping fees, and subscription fees.

CONCLUSIONS

An expanding market for SMAPs with features specific to at-home patient use is emerging. Health care professionals can use these features to select and suggest products that meet their patients' unique requirements.

Eye Drop Adherence With an Eye Drop Bottle Cap Monitor

PRCIS

An eye drop bottle cap monitor with audio and visual alarms measured eye drop adherence in 50 subjects with glaucoma. Baseline adherence rates were too high to test if the alarms could improve adherence.

PURPOSE

To determine if an eye drop bottle cap monitor can measure and improve adherence.

MATERIALS AND METHODS

The Devers Drop Device (D3, Universal Adherence LLC) was designed to measure eye drop adherence by detecting bottle cap removal and replacement, and it can provide text, visual and audio alerts when a medication is due. In Stage 1, we determined baseline adherence for 50 subjects using a nightly eye drop over a 25-day period. Subjects with less than 90% baseline adherence were eligible for Stage 2. In Stage 2, we randomized subjects to receive either no reminder or automated D3 alerts for their nightly eye drop over a subsequent 25-day period. We defined adherence as the proportion of drops administered within 3 hours of the subjects' scheduled dosing time. Subjects completed 3 questions regarding satisfaction with the device and willingness to pay.

RESULTS

The D3 monitor remained attached to the eye drop bottle cap for the duration of the study and collected adherence data in all 50 patients. In Stage 1, the mean adherence rate was 90 ± 18% (range 32-100%). Forty (80%) subjects had an adherence rate greater than 90%. Adherence rates were too high in Stage 1 to adequately test the effects of reminders in Stage 2. Ninety-eight percent (49/50) and 96% (48/50) of subjects agreed "the device always stayed attached to the bottle cap" and "I was able to use the device to take the drops", respectively. Patients would pay $61±83 (range $0-400) for a similar device to improve adherence.

CONCLUSIONS

The D3 can measure eye drop adherence. Research subjects reported high satisfaction and willingness to pay for an eye drop bottle cap monitor. Glaucoma patients have high adherence when they are being monitored, and future studies with research subjects screened for poor adherence may further determine the benefit of electronic monitoring of adherence with and without electronic reminders.