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Tabuchi H, Nishimura K, Akada M, Ishikami T, Shirakami T, Kamiura N, Kiuchi Y. Real-world evaluation of novel eye drop bottle sensors: Cloud-based AI support for eye drop adherence. Heliyon 2024; 10:e34167. [PMID: 39092249 PMCID: PMC11292234 DOI: 10.1016/j.heliyon.2024.e34167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/30/2024] [Accepted: 07/04/2024] [Indexed: 08/04/2024] Open
Abstract
Purpose To understand real-world eye drop adherence among glaucoma patients and evaluate the performance of our proposed cloud-based support for eye drop adherence (CASEA). Design Prospective, observational case series. Methods Setting: The Department of Ophthalmology at Tsukazaki Hospital. Patient or study population: Glaucoma patients treated at the hospital from May 2021 to September 2022, with 61 patients initially enrolled. Intervention or observation procedures: Pharmacists guided eye drop administration before the study. Changes in bottle orientation were detected using an accelerometer attached to the container, and acceleration waveforms and date/time data were recorded. Patients visited the clinic during the 4th and 8th weeks to report their eye drop administration, and the data were uploaded to the cloud. Main outcome measures: Two AI models (B-LSTM) were created to analyze the eye drop bottle movement time-series data for patients treating one or both eyes. The models were evaluated by comparing the true administration status with the AI model judgment. Results Four of the 61 study subjects dropped out. The remaining 57 patients achieved recall, precision, and accuracy values of 98.6 %, 98.6 %, and 95.9 %, respectively, for the two-eyes model and 95.8 %, 98.8 %, and 95.6 % for the one-eye model. Three low-accuracy participants (77.1 %, 71.0 %, and 81.0 %) improved to 100 %, 99.1 %, and 100 %, respectively, after undergoing an additional 8-week performance validation using an aid-type container designed to ensure that the bottle was fully inverted during instillation. Conclusions CASEA precisely monitored daily eye drop adherence and enhanced treatment efficacy by identifying patients with difficulty self-medicating. This system has the potential to improve glaucoma patient outcomes by supporting adherence.
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Affiliation(s)
- Hitoshi Tabuchi
- Department of Technology and Design Thinking for Medicine, Hiroshima University, Hiroshima, Japan
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
| | | | - Masahiro Akada
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
| | | | | | - Naotake Kamiura
- Graduate School of Engineering, University of Hyogo, Himeji, Japan
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Bitton E, Bouskila J. Squeezability of eye drop containers used in dry eye disease management. Clin Exp Optom 2024:1-6. [PMID: 38858843 DOI: 10.1080/08164622.2024.2361781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/20/2024] [Indexed: 06/12/2024] Open
Abstract
CLINICAL RELEVANCE Ocular lubricants are the mainstay of dry eye management and are available in a variety of formulations and bottle designs. The squeezability of ocular lubricant bottles may influence administration and compliance. BACKGROUND A key component for managing dry eye disease is the use of ocular lubricants. The different bottle types, each with their unique material strength and dispensing mechanism, may be challenging for patients with limited hand and pinch strength. The aim of this study was to evaluate the force required to expulse a drop from different eye drop containers used in the management of dry eye disease. METHODS The force, in newtons (N), required to expulse a drop from different eye drops was evaluated five times using a force gauge, and divided by bottle type, i.e. tubes, unidose, multidose with preservatives, and multidose preservative free (MDPF) bottles. RESULTS Sixty (n = 60) bottles were examined with 57 eye lubricants and 3 dry eye medications (cyclosporine (0.5% and 0.9%), and lifitegrast). The average force varied depending on the bottle type (tubes 4.28 ± 1.29 N; unidose 14.24 ± 4.83 N; multidose 16.62 ± 5.21 N; MDPF 26.68 ± 8.32 N, p < 0.001). Post-hoc test revealed that MDPF bottles required more force than all other bottle types (p < 0.001), and among those, the ophthalmic squeeze dispenser bottle required significantly more force (p < 0.001). Lifitegrast required more force (17.38 ± 2.13 N) than cyclosporine 0.5% (9.16 ± 0.80 N, p < 0.024) and cyclosporine 0.9% (5.68 ± 0.40 N, p < 0.001), but was not significantly different from unidose ocular lubricants (p > 0.05). CONCLUSION The squeezability of bottles used in dry eye disease management varies with bottle type. Hand and pinch strength should be considered when choosing products for dry eye disease management, as the squeezability of an ophthalmic drop can influence its administration and compliance.
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Affiliation(s)
- Etty Bitton
- School of Optometry, University of Montreal, Montreal, Canada
| | - Joseph Bouskila
- Faculty of Pharmacy, University of Montreal, Montreal, Canada
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Takao E, Ichitani A, Tanito M. Estimation of Topical Glaucoma Medication Over-Prescription and Its Associated Factors. J Clin Med 2023; 13:184. [PMID: 38202191 PMCID: PMC10779581 DOI: 10.3390/jcm13010184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
This study aims to report the disparity between the ideal and actual quantities of eyedrops prescribed to individual glaucoma patients. This retrospective observational study included 676 patients receiving treatment with antiglaucoma topical medication(s) in at least one eye. These patients had follow-up appointments scheduled at mean intervals of 3.4 ± 1.4 months and were actively using antiglaucoma medication. The mean age was 70.4 ± 11.9 years, with 372 (55%) being male. The over-prescription volume was 1.4 ± 1.7 bottles per month for each medication when prescribed for both eyes. Multiple regression analysis revealed that older age (p = 0.03), hyperopic refractive error (p < 0.0001), and the use of multiple medications (p = 0.03) were associated with a larger over-prescription volume, while the use of unit-dose medication only (p < 0.0001) was associated with a smaller over-prescription volume. Factors such as sex, Mini-Cog cognitive function score, best-corrected visual acuity, intraocular pressure, glaucoma type, and a history of cataract surgery were not significantly associated. This study revealed a significant over-prescription of eyedrops for glaucoma patients, with actual prescriptions often exceeding the theoretically ideal amount by 2.4 times, influenced by factors like age and the format of prescriptions, where unit-dose eyedrops show promise in reducing excess.
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Affiliation(s)
| | | | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo 693-8501, Japan
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Tanito M, Mochiji M, Tsutsui A, Harano A, Ichioka S, Takayanagi Y, Kataoka Y, Takagi Y, Shii D. Factors Associated with Topical Medication Instillation Failure in Glaucoma: VRAMS-QPiG Study. Adv Ther 2023; 40:4907-4918. [PMID: 37707675 PMCID: PMC10567858 DOI: 10.1007/s12325-023-02646-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION To report eyedrop instillation techniques and factors associated with instillation failure among glaucoma subjects in the Video-Recorded Assessment of Medication Skill and Questionnaire-based evaluation of Perception in Glaucoma Study. METHODS In this cross-sectional observational study, subjects were 60 patients with glaucoma (mean ± standard deviation age, 68.4 ± 11.3 years; 30 men) who required ocular hypotensive medication(s). Subjects completed ophthalmologic examinations and the Mini-Cog cognitive function test; their typical eyedrop instillation technique was video-recorded. Subjects rated their technique as successes/failures by questionnaire and two examiners rated the successes/failures based on video assessment. Discrepancy between self-reported and video-assessed success/failure rates of instillation was the main outcome measures. Multivariate logistic regression identified factors in instillation failure. RESULTS Of 48/56 (86%) self-reported successes, 27/48 (56%) failed based on video assessment; as a result, 32/56 (57%) were inconsistent between subjective and objective assessments. Overall, 30/56 (54%) failed based on video assessment. In the subject-based data model, older age [odds ratio (OR) 0.93/year, P = 0.025] and lower cognitive function score (OR 2.7/score, P = 0.025) were factors in failed instillations. In the eye-based data model, less myopic objective refractive error (OR 0.77/diopter, P = 0.016) and lower visual field foveal threshold (OR 1.1/decibel, P = 0.041) were factors in failures. CONCLUSION In addition to older age, decreased cognitive function, hyperopia, and decreased foveal sensitivity are risks for failed eyedrop instillation. Treating physicians can screen patients who require guidance by checking the risk factors of instillation failure rather than by relying on patient reports.
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Affiliation(s)
- Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, Japan.
| | - Mihoko Mochiji
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, Japan
| | - Aika Tsutsui
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, Japan
| | - Akiko Harano
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, Japan
| | - Sho Ichioka
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, Japan
| | - Yuji Takayanagi
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, Japan
| | - Yumiko Kataoka
- Japan Medical Affairs Group, Santen Pharmaceutical Co., Ltd., 4-20 Ofukacho, Kita-ku, Osaka, Japan
| | - Yasutaka Takagi
- Japan Medical Affairs Group, Santen Pharmaceutical Co., Ltd., 4-20 Ofukacho, Kita-ku, Osaka, Japan
| | - Daisuke Shii
- Japan Medical Affairs Group, Santen Pharmaceutical Co., Ltd., 4-20 Ofukacho, Kita-ku, Osaka, Japan
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Grissom N, Gardiner SK, Rees JP, Sanchez FG, Mansberger SL, Cunningham ET, Burgoyne CF, Rice K, Belter C, Kinast RM. Patients with Low Vision Struggle with Placing Eye Drops and Benefit from an Eye Drop Aid. Ophthalmol Glaucoma 2023; 6:501-508. [PMID: 37084868 DOI: 10.1016/j.ogla.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE To evaluate eye drop self-administration in a low-vision patient population and test whether a nose-pivoted drop delivery device (NPDD, GentleDrop) can improve eye drop delivery in these patients. DESIGN Repeated-measures case series. PARTICIPANTS Thirty subjects (58 eyes) with low vision, defined as best-corrected visual acuity worse than 20/60 or visual field worse than 20° in the better-seeing eye. METHODS We video-recorded subjects while self-administering eye drops using their own traditional delivery at baseline, after a standardized teaching, and with an NPDD. Two masked graders independently reviewed each drop delivery. Primary success was defined as the drop reaching the eye without the bottle touching the eye or eyelids. Subjects rated ease-of-use (1-10 scale, 10 = easiest) after each drop delivery and completed a satisfaction survey, which included asking whether subjects could place drops independently (1-5 scale, 5 = most independent). MAIN OUTCOME MEASURES Logistic-transformed generalized estimating equation regression to compare technique satisfaction, ease-of-use, independence, no contact, and success. RESULTS Primary success was observed in 30 (52%) of 58 eyes at baseline and increased to 44 eyes (76%) with an NPDD (P = 0.013). Bottle tip contact occurred in 23 (40%) of 58 eyes at baseline and 8 eyes (14%) with an NPDD (P = 0.004). Mean ease-of-use scores were 6.7 ± 3.1 at baseline and 8.3 ± 1.8 (P < 0.001) with an NPDD. Likewise, the NPDD improved success, bottle tip contact, and ease-of-use compared with post-teaching traditional delivery (P < 0.01). Twenty-two (73%) of 30 subjects preferred the NPDD to traditional delivery. Twenty-nine (97%) thought the NPDD was comfortable to use, and all would recommend the device. A subgroup analysis was performed on 16 subjects that self-reported difficulty instilling drops at baseline. The NPDD showed similar results, and it increased confidence in placing drops independently (4.6 ± 0.9) compared with baseline (2.7 ± 1.6, P < 0.001). Fifteen (94%) subjects in this subgroup preferred the NPDD. CONCLUSIONS Low-vision subjects struggled to self-administer eye drops. An NPDD can improve bottle tip contact, ease-of-use, satisfaction, and independence. Eye care providers could consider screening low-vision patients about difficulty with eye drop self-administration and recommending eye drop aids. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Jack P Rees
- Legacy Devers Eye Institute, Portland, Oregon
| | - Facundo G Sanchez
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Steven L Mansberger
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California; The Francis I. The Proctor Foundation, UCSF School of Medicine, San Francisco, California
| | - Claude F Burgoyne
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Karen Rice
- Legacy Devers Eye Institute, Portland, Oregon
| | | | - Robert M Kinast
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon.
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Hauswirth SG, Kabat AG, Hemphill M, Somaiya K, Hendrix LH, Gibson AA. Safety, adherence and discontinuation in varenicline solution nasal spray clinical trials for dry eye disease. J Comp Eff Res 2023; 12:e220215. [PMID: 37096956 PMCID: PMC10402908 DOI: 10.57264/cer-2022-0215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/11/2023] [Indexed: 04/26/2023] Open
Abstract
Aim: Herein, we report safety outcomes for varenicline solution nasal spray (VNS) within the context of clinical trial discontinuation, contrasting those with discontinuation outcomes from topical cyclosporine and lifitegrast clinical trials. Materials & methods: 1061 subjects were randomized across three clinical trials to receive either VNS 0.06 mg, VNS 0.03 mg, VNS 0.006 mg or vehicle control. Subjects who discontinued from treatment were noted and assigned to their appropriate categories. Results: Despite treatment emergent adverse events, 93.5% of subjects receiving VNS completed the treatment period. By comparison, only 80% of subjects in the integrated clinical trials for cyclosporine ophthalmic emulsion and 91% of subjects in the integrated trials for lifitegrast ophthalmic solution completed the full treatment period, respectively. Conclusion: In clinical trials, VNS demonstrated improvements in dry eye disease signs and symptoms, was well-tolerated, and had an overall completion rate >93%. Conventional dry eye treatments (e.g., cyclosporine and lifitegrast) noted considerably higher discontinuation rates in their clinical trials.
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Affiliation(s)
- Scott G Hauswirth
- University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Alan G Kabat
- Oyster Point Pharmaceuticals, Princeton, NJ 08540, USA
- Salus University, Elkins Park, PA 19027, USA
| | | | - Karan Somaiya
- Oyster Point Pharmaceuticals, Princeton, NJ 08540, USA
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Williams AM, Theophanous C, Muir KW, Rosdahl JA, Woolson S, Olsen M, Bosworth HB, Hung A. Within-Trial Cost-Effectiveness of an Adherence-Enhancing Educational Intervention for Glaucoma. Am J Ophthalmol 2022; 244:216-227. [PMID: 36002073 PMCID: PMC10084845 DOI: 10.1016/j.ajo.2022.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess the within-trial cost-effectiveness of a behavioral intervention to improve glaucoma medication adherence. DESIGN Prospective cost-effectiveness analysis of randomized, controlled trial data. METHODS The study setting was a Veterans Affairs (VA) eye clinic. The patient population comprised veterans with medically treated glaucoma and self-reported poor adherence. Participants were randomized to a personalized educational session with a reminder bottle to promote medication adherence or to a control session on general eye health. Costs were assessed from the perspective of the VA payor at 6 months using the VA Managerial Cost Accounting System. Probabilistic sensitivity analyses were conducted using bootstrapped samples. The main outcome measures were the proportion of participants attaining ≥80% adherence as measured by electronic monitor, total intervention and medical resource costs, and incremental cost-effectiveness ratios comparing intervention to control at 6 months. RESULTS Of 200 randomized participants, 95 of 100 assigned to the intervention and 97 of 100 assigned to the control had adherence outcomes at 6 months, and the proportion of adherent patients was higher in the intervention group compared to control (0.78 vs 0.40, P < .0001). All participants had costs at 6 months. The total cost at 6 months was $1,149,600 in the intervention group (n = 100) compared to $1,298,700 in the control group (n = 100). Thus, in a hypothetical cohort of 100 patients, the intervention was associated with cost savings (-$149,100) and resulted in 38 additional patients achieving medication adherence. CONCLUSIONS An adherence-enhancing behavioral intervention was effective and cost saving at 6 months.
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Affiliation(s)
- Andrew M Williams
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA; Department of Ophthalmology (A.M.W.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Christos Theophanous
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelly W Muir
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA; Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
| | - Jullia A Rosdahl
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Maren Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Hayden B Bosworth
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA; Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Anna Hung
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA; Department of Population Health Sciences (A.H.), Duke University School of Medicine, Durham, NC, United States; Duke-Margolis Center for Health Policy (A.H.), Duke University, Durham, NC, United States
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Zingale E, Romeo A, Rizzo S, Cimino C, Bonaccorso A, Carbone C, Musumeci T, Pignatello R. Fluorescent Nanosystems for Drug Tracking and Theranostics: Recent Applications in the Ocular Field. Pharmaceutics 2022; 14:pharmaceutics14050955. [PMID: 35631540 PMCID: PMC9147643 DOI: 10.3390/pharmaceutics14050955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 12/14/2022] Open
Abstract
The greatest challenge associated with topical drug delivery for the treatment of diseases affecting the posterior segment of the eye is to overcome the poor bioavailability of the carried molecules. Nanomedicine offers the possibility to overcome obstacles related to physiological mechanisms and ocular barriers by exploiting different ocular routes. Functionalization of nanosystems by fluorescent probes could be a useful strategy to understand the pathway taken by nanocarriers into the ocular globe and to improve the desired targeting accuracy. The application of fluorescence to decorate nanocarrier surfaces or the encapsulation of fluorophore molecules makes the nanosystems a light probe useful in the landscape of diagnostics and theranostics. In this review, a state of the art on ocular routes of administration is reported, with a focus on pathways undertaken after topical application. Numerous studies are reported in the first section, confirming that the use of fluorescent within nanoparticles is already spread for tracking and biodistribution studies. The first section presents fluorescent molecules used for tracking nanosystems’ cellular internalization and permeation of ocular tissues; discussions on the classification of nanosystems according to their nature (lipid-based, polymer-based, metallic-based and protein-based) follows. The following sections are dedicated to diagnostic and theranostic uses, respectively, which represent an innovation in the ocular field obtained by combining dual goals in a single administration system. For its great potential, this application of fluorescent nanoparticles would experience a great development in the near future. Finally, a brief overview is dedicated to the use of fluorescent markers in clinical trials and the market in the ocular field.
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Affiliation(s)
- Elide Zingale
- Department of Pharmaceutical and Health Sciences, University of Catania, 95124 Catania, Italy; (E.Z.); (A.R.); (S.R.); (C.C.); (A.B.); (C.C.); (T.M.)
| | - Alessia Romeo
- Department of Pharmaceutical and Health Sciences, University of Catania, 95124 Catania, Italy; (E.Z.); (A.R.); (S.R.); (C.C.); (A.B.); (C.C.); (T.M.)
| | - Salvatore Rizzo
- Department of Pharmaceutical and Health Sciences, University of Catania, 95124 Catania, Italy; (E.Z.); (A.R.); (S.R.); (C.C.); (A.B.); (C.C.); (T.M.)
| | - Cinzia Cimino
- Department of Pharmaceutical and Health Sciences, University of Catania, 95124 Catania, Italy; (E.Z.); (A.R.); (S.R.); (C.C.); (A.B.); (C.C.); (T.M.)
| | - Angela Bonaccorso
- Department of Pharmaceutical and Health Sciences, University of Catania, 95124 Catania, Italy; (E.Z.); (A.R.); (S.R.); (C.C.); (A.B.); (C.C.); (T.M.)
- NANO-i—Research Center for Ocular Nanotechnology, University of Catania, 95124 Catania, Italy
| | - Claudia Carbone
- Department of Pharmaceutical and Health Sciences, University of Catania, 95124 Catania, Italy; (E.Z.); (A.R.); (S.R.); (C.C.); (A.B.); (C.C.); (T.M.)
- NANO-i—Research Center for Ocular Nanotechnology, University of Catania, 95124 Catania, Italy
| | - Teresa Musumeci
- Department of Pharmaceutical and Health Sciences, University of Catania, 95124 Catania, Italy; (E.Z.); (A.R.); (S.R.); (C.C.); (A.B.); (C.C.); (T.M.)
- NANO-i—Research Center for Ocular Nanotechnology, University of Catania, 95124 Catania, Italy
| | - Rosario Pignatello
- Department of Pharmaceutical and Health Sciences, University of Catania, 95124 Catania, Italy; (E.Z.); (A.R.); (S.R.); (C.C.); (A.B.); (C.C.); (T.M.)
- NANO-i—Research Center for Ocular Nanotechnology, University of Catania, 95124 Catania, Italy
- Correspondence:
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van Riet-Nales DA, van den Bemt B, van Bodegom D, Cerreta F, Dooley B, Eggenschwyler D, Hirschlérova B, Jansen PAF, Karapinar-Çarkit F, Moran A, Span J, Stegemann S, Sundberg K. Commentary on the EMA reflection paper on the pharmaceutical development of medicines for use in the older population. Br J Clin Pharmacol 2022; 88:1500-1514. [PMID: 35141926 DOI: 10.1111/bcp.15207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022] Open
Abstract
Older people are often affected by impaired organ and bodily functions resulting in multimorbidity and polypharmacy, turning them into the main user group of many medicines. Very often, medicines have not specifically been developed for older people, causing practical medication problems for them like limited availability of easy to swallow formulations, easy to open packaging and dosing instructions for enteral administration. In 2020, the European Medicines Agency (EMA) published a reflection paper 'Pharmaceutical development of medicines for use in the older population', which discusses how the emerging needs of an ageing European population can be addressed by medicines regulation. The paper intends to help industry to better consider the needs of older people during pharmaceutical/clinical medicines development by summarising data on the most relevant topics, providing early suggestions on how to move forward and prompting expert discussions and studies into knowledge gaps. Topics include patient acceptability, (dis)advantages of an administration route, formulation, dosage form, packaging, dosing device and user instruction. While the paper is directed at older people and the pharmaceutical industry, the reflections are also relevant to younger patients with similar disease-related needs and of value to other stakeholders parties, e.g., healthcare professionals, academics, patients and caregivers, as the paper makes clear what can be expected from industry and where collaborative work is needed. This commentary provides an overview of the different steps in the development of the reflection paper, discusses points considered most controversial and/or subject to (multidisciplinary) expert discussions and indicates their value for real world clinical practice.
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Affiliation(s)
- Diana A van Riet-Nales
- Department of Chemical Pharmaceutical Assessments, Medicines Evaluation Board (MEB), Utrecht, Netherlands
| | - Bart van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, Netherlands.,Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - David van Bodegom
- Public Health and Primary Care, Leyden Academy on Vitality and Ageing, Leiden, Netherlands.,Department Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Francesca Cerreta
- Scientific Evidence Generation Department, Human Medicines Division, European Medicines Agency, Amsterdam, Netherlands
| | - Brian Dooley
- Quality and Safety of Medicines Department, Human Medicines Division, European Medicines Agency, Amsterdam, Netherlands
| | | | - Blanka Hirschlérova
- Department of Pharmaceutical Assessment of Chemical and Herbal Products, State Institute for Drug Control (SUKL), Prague, Czech Republic
| | - Paul A F Jansen
- Department of Chemical Pharmaceutical Assessments, Medicines Evaluation Board (MEB), Utrecht, Netherlands.,Geriatric Department, University Medical Center, Utrecht, Netherlands.,Expertise Centre Pharmacotherapy in Old Persons (EPHOR), Utrecht, Netherlands
| | | | - Abigail Moran
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Jan Span
- Department of Chemical Pharmaceutical Assessments, Medicines Evaluation Board (MEB), Utrecht, Netherlands
| | - Sven Stegemann
- Institute of Process and Particle Engineering, Graz University of Technology, Graz, Austria
| | - Katarina Sundberg
- Department of Pharmaceutics and Biotechnology, Swedish Medical Products Agency (MPA), Uppsala, Sweden
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10
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Kim DJ, Jung MY, Park JH, Pak HJ, Kim M, Chuck RS, Park CY. Moxifloxacin releasing intraocular implant based on a cross-linked hyaluronic acid membrane. Sci Rep 2021; 11:24115. [PMID: 34916593 PMCID: PMC8677739 DOI: 10.1038/s41598-021-03605-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/07/2021] [Indexed: 11/09/2022] Open
Abstract
Intraocular antibiotic delivery is an important technique to prevent bacterial infection after ophthalmic surgery, such as cataract surgery. Conventional drug delivery methods, such as antibiotic eye drops, have limitations for intraocular drug delivery due to the intrinsic barrier effect of the cornea. Therefore, frequent instillation of antibiotic eyedrops is necessary to reach a sufficient bactericidal concentration inside the eye. In this study, an intraocular implant, MXF-HA, that combines hyaluronic acid (HA) and moxifloxacin (MXF) was developed to increase the efficiency of intraocular drug delivery after surgery. MXF-HA is manufactured as a thin, transparent, yellow-tinted membrane. When inserted into the eye in a dry state, MXF-HA is naturally hydrated and settles in the eye, and the MXF contained therein is delivered by hydrolysis of the polymer over time. It was confirmed through in vivo experiments that MXF delivery was maintained in the anterior chamber of the eye at a concentration sufficient to inhibit Pseudomonas aeruginosa and Staphylococcus aureus for more than 5 days after implantation. These results suggest that MXF-HA can be utilized as a potential drug delivery method for the prevention and treatment of bacterial infections after ophthalmic surgery.
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Affiliation(s)
- Dong Ju Kim
- Department of Ophthalmology, Graduate School of Medicine, Dongguk University, Seoul, South Korea
| | - Mi-Young Jung
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, Kyunggido, 410-773, South Korea
| | - Joo-Hee Park
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, Kyunggido, 410-773, South Korea
| | - Ha-Jin Pak
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, Kyunggido, 410-773, South Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, Kyunggido, 410-773, South Korea
| | - Roy S Chuck
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Choul Yong Park
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, Kyunggido, 410-773, South Korea.
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11
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Comparison of the Usability of Eye Drop Aids and the Conventional Bottle. J Clin Med 2021; 10:jcm10235658. [PMID: 34884360 PMCID: PMC8658337 DOI: 10.3390/jcm10235658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Eye drops are the most common route of administration for ophthalmic medications. Administering drops can be a major hurdle for patients, potentially resulting in noncompliance and treatment failure. The purpose of this study is to compare the efficacy and safety of two different aids and the conventional bottle for eye drop instillation; (2) Methods: An interventional crossover study involving standard eye drop bottle, Opticare aid and Autodrop aid. The study included healthy subjects without a history of regular eye drop use; (3) Results: Twenty-six subjects were enrolled. Of those subjects, 96% and 92% were able to assemble the eye drop bottle into the Autodrop and the Opticare aids, respectively. Subjective assessment indicated that Autodrop was significantly easier to assemble than Opticare (95% CI: -1.6802 to -0.1659, p = 0.02). When using either aid, there was no contamination of the bottle tip, which occurred in 46% of subjects when no aid was used (p = 0.0005). Fewer drops were expelled when using the conventional bottle as compared to the aids (p = 0.05 compared to Autodrop, p = 0.1 compared to Opticare); (4) Conclusions: Autodrop and Opticare can assist patients with eye drop placement. These aids completely prevented bottle tip contamination, which was frequently observed when the conventional bottle was used alone.
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12
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Adherence With Glaucoma Medications: Barriers to Success and Prospects for Improvement. CURRENT OPHTHALMOLOGY REPORTS 2021. [DOI: 10.1007/s40135-021-00273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Zhu CQ, Sadlak N, Fiorello MG, Lee D, Desai M. A Comparison of Patient Acceptance of 3 Eye Drop Instillation Aids. J Glaucoma 2021; 30:725-731. [PMID: 34049349 PMCID: PMC8366596 DOI: 10.1097/ijg.0000000000001891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
PRECIS Patients can be quite amenable to using eye drop instillation aids. We should consider recommending these devices to patients who otherwise struggle with drop instillation and medication adherence. PURPOSE The purpose of this study was to compare patient acceptance of 3 commercially available eye drop instillation aids in a diverse tertiary care population. METHODS In this prospective, randomized controlled study, 39 patients being treated with topical antihypertensives were assigned to Arm A (no intervention) or Arm B (AutoDrop, AutoSqueeze, or SimplyTouch). Subjects in Arm B were instructed to administer their eye drop with the assigned drop aid at every use for ~6 weeks. Satisfaction surveys were administered at 3 and 6 weeks, where patients also reported the number of drops missed. RESULTS Thirty-two of 39 subjects completed study participation and full data analysis. Within this total group, 24 subjects were randomized to drop aids (AutoDrop N=10, AutoSqueeze N=8, SimplyTouch N=6), and 8 were randomized to no drop aid. At the 3 and 6-week timepoints, patients found instillation easier with AutoDrop (70.0%, 60.0%) followed by the AutoSqueeze (62.5%, 75.0%), and lastly SimplyTouch (33.3%, 33.3%). For the AutoSqueeze, the mean number of drops missed with and without the drop aid were significantly different (P=0.015 at 3 wk, P=0.008 at 6 wk). There was no difference in the mean number of drops missed with the AutoDrop and SimplyTouch at either timepoint. CONCLUSIONS For the AutoDrop and AutoSqueeze groups, over 60% of the patients found the devices helpful and would consider using them long-term. Our results suggest that patients would be amenable to using eye drop instillation aids, although more objective data is needed to determine whether these devices would improve medication compliance and clinical outcomes.
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Affiliation(s)
| | | | | | - Deborah Lee
- Boston Medical Center, Boston University School of Medicine
| | - Manishi Desai
- Boston Medical Center, Boston University School of Medicine
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14
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Shukla AG, Muir KW, Myers JS. Pivoting from Traditional Eye Drop Administration. Ophthalmol Glaucoma 2021; 4:437-439. [PMID: 34090849 DOI: 10.1016/j.ogla.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/09/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
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15
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Wuchte LD, DiPasquale SA, Byrne ME. In vivo drug delivery via contact lenses: The current state of the field from origins to present. J Drug Deliv Sci Technol 2021; 63:102413. [PMID: 34122626 PMCID: PMC8192067 DOI: 10.1016/j.jddst.2021.102413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the past half century, contact lenses have been investigated for their potential as drug delivery devices for ocular therapeutics. Hundreds of studies have been published in the pursuit of the most effective and efficient release strategies and methods for contact lens drug delivery. This paper provides a thorough overview of the various contact lens drug delivery strategies, with a specific, comprehensive focus on in vivo studies that have been published since the field began in 1965. Significant accomplishments, current trends, as well as future strategies and directions are highlighted. In vivo study analysis provides a straightforward perspective and assessment of method success and commercialization potential in comparison to benchtop, in vitro studies. Analysis of the majority of published work indicates in vitro and in vivo studies do not correlate with a correlation coefficient of 0.25, with many in vitro studies grossly overestimating drug release duration and not showing appreciable drug release control. However, there has been an increase in activity in the last decade, and some methods have generated promising results exhibiting controlled release with commercialization potential. Clinical translation of drug releasing lenses is on the horizon and has high potential to impact a large number of patients providing efficacious treatment compared to current topical treatments.
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Affiliation(s)
- Liana D. Wuchte
- Biomimetic & Biohybrid Materials, Biomedical Devices, & Drug Delivery Laboratories, Department of Biomedical Engineering, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA
| | - Stephen A. DiPasquale
- Biomimetic & Biohybrid Materials, Biomedical Devices, & Drug Delivery Laboratories, Department of Biomedical Engineering, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA
- OcuMedic, Inc, 107 Gilbreth Parkway, Mullica Hill, NJ, 08062, USA
| | - Mark E. Byrne
- Biomimetic & Biohybrid Materials, Biomedical Devices, & Drug Delivery Laboratories, Department of Biomedical Engineering, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA
- OcuMedic, Inc, 107 Gilbreth Parkway, Mullica Hill, NJ, 08062, USA
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16
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Kang JM, Chatterjee A, Rosdahl JA, Bosworth HB, Woolson S, Olsen M, Sexton M, Kirshner M, Muir KW. Health Literacy and Success with Glaucoma Drop Administration. Ophthalmol Glaucoma 2021; 5:26-31. [PMID: 34052458 DOI: 10.1016/j.ogla.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the relationship between health literacy and successful glaucoma drop administration. DESIGN Substudy of a single-site interventional randomized controlled trial. PARTICIPANTS Veterans receiving care at the Durham Veterans Affairs Eye Clinic who had a diagnosis of open-angle glaucoma were recruited if they endorsed poor drop adherence. METHODS Participants underwent a health literacy evaluation using the Rapid Estimate of Adult Literacy in Medicine (REALM) as well as a qualitative assessment of eye drop administration technique using 3 different criteria: (1) the drop was instilled in the eye, (2) only 1 drop was dispensed, and (3) the bottle was not potentially contaminated. A multivariate logistic regression model was used to assess the association of REALM score and successful drop administration, adjusting for age, disease severity, and Veterans Administration Care Assessment Needs (CAN) score. MAIN OUTCOME MEASURES Successful drop administration. RESULTS Of the 179 participants with REALM scores and observed drop administration, 78% read at a high school level (HSL) or more and 22% read at less than HSL. Of the 179 participants, 87% (n = 156) successfully instilled the drop into the eye (criterion 1). A greater proportion of participants who read at HSL or more successfully instilled the drop in the eye compared with those reading at less than HSL (90.6% vs. 75.0%; P = 0.02). Rates of success with criterion 1 were similar across different levels of visual field severity. Care Assessment Needs scores were not statistically significant between those who did and those did not have successful overall drop technique. CONCLUSIONS Poor health literacy may be associated with decreased successful drop instillation in the eye in patients with glaucoma. Screening for and considering health literacy in developing interventions to improve glaucoma self-management may improve treatment adherence in a vulnerable population.
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Affiliation(s)
- J Minjy Kang
- Department of Ophthalmology, Northwestern University, Chicago, Illinois
| | - Ayan Chatterjee
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Hayden B Bosworth
- Department of Ophthalmology, Duke University, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina
| | | | - Maren Olsen
- Department of Ophthalmology, Duke University, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina
| | - Malina Sexton
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Kelly W Muir
- Department of Ophthalmology, Duke University, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina.
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17
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Kashiwagi K, Matsuda Y, Ito Y, Kawate H, Sakamoto M, Obi S, Haro H. Investigation of visual and physical factors associated with inadequate instillation of eyedrops among patients with glaucoma. PLoS One 2021; 16:e0251699. [PMID: 33989342 PMCID: PMC8121298 DOI: 10.1371/journal.pone.0251699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/02/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to investigate the frequency of eyedrop instillation failure and its related physical and visual function factors among glaucoma patients who used hypotensive eyedrops daily. Subjects and methods Patients with a history of self-instillation of one or more ocular hypotensive ophthalmic solutions for six or more months were enrolled. Definitions of instillation failure were eyedrop instillation other than on the eye surface; eyedrop contact with eyelashes; eyedrop bottle tip contact with the eyelashes, eye surface or ocular adnexa; or two or more drops instilled with one instillation trial. To clarify factors related to instillation failure, we used visual function tests and investigated cervical spine extension angles during instillation, pinching strength, physical ataxia (evaluated using the Scale for the Assessment and Rating of Ataxia), motor dysfunction of the upper limbs (evaluated using the Disabilities of the Arm, Shoulder and Hand questionnaire), and vision quality (evaluated using the National Eye Institute Visual Function Questionnaire 25). Results Of 103 total subjects, 61.2% satisfied the definition of instillation failure. Instillation of the eyedrop other than at the cul-desac (76.2%) was the most frequent reason for failure, followed by contact of the tip of the eyedrop bottle (22.2%) and instillation of the same or more than two eyedrops in a single attempt (11.1%). Advanced age, a shallow cervical spine extension angle, weak pinching strength, poor motor dysfunction of the upper limbs, the degree of ataxia, poor best-corrected visual acuity, and visual field scores were significant risk factors for instillation failure. Vision quality may have some relation to instillation failure. Conclusion It is highly recommended that instillation failure be routinely investigated even among patients with adequate experience using eyedrops and that correct therapies are chosen in a patient-based fashion.
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Affiliation(s)
- Kenji Kashiwagi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
- * E-mail:
| | - Yuji Matsuda
- Division of Rehabilitation, University of Yamanashi Hospital, Yamanashi, Japan
| | - Yuka Ito
- Department of Nursing, University of Yamanashi Hospital, Yamanashi, Japan
| | - Hisami Kawate
- Department of Nursing, University of Yamanashi Hospital, Yamanashi, Japan
| | - Masako Sakamoto
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shinji Obi
- Division of Rehabilitation, University of Yamanashi Hospital, Yamanashi, Japan
| | - Hirotaka Haro
- Division of Rehabilitation, University of Yamanashi Hospital, Yamanashi, Japan
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18
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Sanchez FG, Mansberger SL, Kung Y, Gardiner SK, Burgoyne CF, Cunningham ET, Rees JP, Jones EP, Kinast RM. Novel Eye Drop Delivery Aid Improves Outcomes and Satisfaction. Ophthalmol Glaucoma 2021; 4:440-446. [PMID: 33444854 DOI: 10.1016/j.ogla.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare a nose-pivoted drop delivery device (NPDD) with traditional eye drop delivery in glaucoma subjects. DESIGN Repeated-measures case series. PARTICIPANTS Fifty glaucoma subjects (100 eyes) who reported difficulty self-administering eye drops. METHODS We compared eye drop delivery using a NPDD against traditional delivery techniques at baseline (baseline traditional) and after standardized teaching (post-teaching traditional). Subjects used a 1-to-10 scale (10 being easiest) to rate the ease of delivery with each technique and completed a satisfaction survey. Two graders used digital video to independently review eye drop delivery and recorded: (1) accurate placement: the eye drop reached the ocular surface; (2) no contact: no bottle tip contact against the ocular or periocular surface; and (3)number of eye drops dispensed. We defined primary success as accurate placement and no contact; secondary success as primary success with only 1 drop dispensed. MAIN OUTCOME MEASURES We used logistic-transformed generalized estimating equation (GEE) regression to compare technique satisfaction, accuracy, no contact, and primary and secondary success. Number of drops dispensed was compared using a Cox model. RESULTS Forty-seven of 50 subjects (94%) preferred the NPDD over traditional eye drop delivery. The mean score for ease of use was higher for the NPDD (8.9 ± 1.1) than baseline traditional (6.7 ± 2.1; P < 0.001) and post-teaching traditional (7.0 ± 2.0; P < 0.001). Forty-nine of 50 (98%) subjects thought the NPDD was comfortable to use and would recommend the device. The eye drop reached the ocular surface in a similar percentage of subjects (>90%) with each method. The bottle tip contacted fewer eyes with the NPDD (10 eyes) than baseline traditional (33 eyes; P < 0.001) and post-teaching traditional (25 eyes; P = 0.009). The number of drops dispensed was lower with the NPDD (1.7 ± 1.2) than baseline traditional (2.2 ± 1.6; P = 0.017) and post-teaching traditional (2.4 ± 1.8; P = 0.006). The NPDD increased primary and secondary success of eye drop delivery (86% and 54%, respectively) compared to baseline traditional (66% [P = 0.001] and 28% [P < 0.001]) and post-teaching traditional (70% [P = 0.005] and 40% [P = 0.018]). CONCLUSIONS Eye drop users preferred the NPDD over traditional eye drop delivery. The NPDD improved eye drop delivery success, reduced bottle tip contact, and decreased the number of eye drops wasted.
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Affiliation(s)
- Facundo G Sanchez
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Steven L Mansberger
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | | | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Claude F Burgoyne
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; Department of Ophthalmology, Stanford University School of Medicine, Stanford, California; The Francis I. Proctor Foundation, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Jack P Rees
- Legacy Devers Eye Institute, Portland, Oregon
| | | | - Robert M Kinast
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon.
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19
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Tapply I, Broadway DC. Improving Adherence to Topical Medication in Patients with Glaucoma. Patient Prefer Adherence 2021; 15:1477-1489. [PMID: 34239297 PMCID: PMC8259615 DOI: 10.2147/ppa.s264926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022] Open
Abstract
The glaucomas form a heterogenous group of conditions, which collectively account for one of the most common irreversible causes of blindness worldwide. The only treatment, for which there is evidence, to stop or slow glaucomatous disease progression is to lower intraocular pressure (IOP); this is most often initially achieved with topical medication. Adherence to anti-glaucoma therapy is known to be low even when compared with adherence to therapy for other chronic conditions. We performed a PubMed search to review evidence as to how adherence to and persistence with anti-glaucoma medications might be improved. Approaches to improving adherence include technological (such as using smart drop bottles or automated reminders) use of instillation aids, improving communication with patient education and improving tolerability of eye drop formulations. There is limited short-term evidence that automated reminders can be effective and, unfortunately, instillation aids have not proved to be efficacious with respect to improving adherence. A range of factors have been identified which affect adherence and persistence, although only a multi-faceted approach has proven evidence of efficacy, compared to improved patient education alone. There is now a wider range of available preservative-free eye drops, which have been shown to be non-inferior in achieving IOP control, with fewer side effects and improved short-term adherence. Further studies relating to adherence are warranted, particularly given the projected increase in glaucoma prevalence worldwide.
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Affiliation(s)
- Ian Tapply
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
- Department of Ophthalmology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
- Correspondence: Ian Tapply Department of Ophthalmology, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UKTel +44 7810 583319 Email
| | - David C Broadway
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
- School of Pharmacy, University of East Anglia, Norwich, NR4 7TJ, UK
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20
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Sakiyalak D, Kobwanthanakun S. Patients' Experience of Using Eye Drop Guide Device to Aid Self-Administration of Glaucoma Medications. Clin Ophthalmol 2020; 14:3781-3788. [PMID: 33177804 PMCID: PMC7650028 DOI: 10.2147/opth.s271673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To determine the characteristics of the patients who preferred using the eye drop guide (EDG) regularly and their opinions toward the guide in order to select the patients for prescribing the EDG appropriately. Patients and Methods Fifty-seven glaucoma patients who completed the primary study, “The effect of ‘eye drop guide’ on the success rate of eye drop self-instillation in glaucoma patients”, were included. Patients’ instillation techniques, routine instillation or using the EDG, were chosen independently. After 4–6 months, they were interviewed about the frequency of EDG use and their rating scores toward the guide in 4 aspects including aiming aids, contamination prevention, reduction of drop waste, and ease of use. The differences in opinion scores between each frequency group and the factors associated with the regularity of EDG use were statistically analyzed. Results Of fifty-seven patients completing the interview, 19.3% used the EDG everyday, while 45.6% had never used the EDG. The nonusers rated significantly lower scores in all aspects (p-value < 0.005). From multivariate analysis, the factors associated with the preference not to use the EDG were administering in supine position (p-value < 0.001, adjusted OR 34.866, 95% CI 4.974–244.412) and more than one eye drop use (p-value = 0.048, adjusted OR 5.280, 95% CI 1.018–27.396). Conclusion The EDG should be selectively prescribed for the particular patients who had one medication and performed instillation in sitting or standing position. Although the regular EDG users tended to have positive opinions on the EDG, their long-term compliance with the guide was underinvestigated.
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Affiliation(s)
- Darin Sakiyalak
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirinya Kobwanthanakun
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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21
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Law GC, Bülbül A, Jones CJ, Smith H. 'The mean mummy way' - experiences of parents instilling eye drops to their young children as described in online forums and blogs. BMC Pediatr 2020; 20:514. [PMID: 33167925 PMCID: PMC7653738 DOI: 10.1186/s12887-020-02410-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adults often have difficulty instilling eye drops in their own eyes, but little has been documented about the difficulties experienced by parents when administering eye drops to their young children, where the challenges of instillation are accentuated by their inability to cooperate. This qualitative study explores parents' experiences of administering eye drops to their children as described in online forum discussions and blog posts. METHODS This was an exploratory study using qualitative methods. We thematically analysed the written exchanges between parents participating in online forum discussions and blog posts about the administration of eye drops to their young children. RESULTS We found 64 forum discussion threads and 4 blog posts, representing 464 unique contributors expressing their experiences of eye drop administration to young children. Three major themes were identified - administration challenges, administration methods and role of health care professionals. Besides describing their children's distress, parents discussed their own discomfort and anxiety when administering eye drops. Parents used a variety of techniques to facilitate adherence with medication, including restraining the child, role-play, reassurance, distraction, or reward. The ideas exchanged about eye drop administration occasionally included reiteration of professional advice, but were dominated by parents' own ideas/suggestions; interestingly health care professionals were considered diagnosticians and prescribers, rather than sources of practical advice on administration. CONCLUSIONS Parents struggling to deliver eye drops to their young children may seek advice on how to administer treatment from parental on-line discussion forums. The distress experienced by the young child and their parents is a powerful reminder to clinicians that procedures common and routine in health care may be challenging to parents. The advice given to parents needs to go beyond the instillation of the eye drops, and include advice on child restraint, distraction techniques and allaying distress. Forewarned of the potential difficulties and provided with coping strategies parents can employ when the child resists, could alleviate their own and their child's distress.
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Affiliation(s)
- Gloria C. Law
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232 Singapore
| | | | | | - Helen Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232 Singapore
- Brighton and Sussex Medical School, Brighton, UK
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22
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Freddo TF, Ho DY, Steenbakkers M, Furtado N. Validation of a More Reliable Method of Eye Drop Self-Administration. Optom Vis Sci 2020; 97:496-502. [PMID: 32697556 DOI: 10.1097/opx.0000000000001535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE We propose an alternative method for eye drop self-administration. Similar IOP reductions were found with this method compared with clinician instillation. The alternative method of self-administration potentially benefits patients who have trouble successfully instilling drops. PURPOSE The purpose of this study was to validate the efficacy of an alternative method of drop instillation. METHODS This study is a randomized controlled crossover clinical trial. Thirty participants were recruited. A drop of 0.5% timolol maleate was instilled into subject's eye on two separate visits. On one visit, eye drop instillation was by a trained clinician, and on the other, self-instillation using an alternative method was used. The order was randomly chosen. Intraocular pressure was measured before drop instillation and 2 hours after drop instillation. The investigator was masked during measurement, and an observer recorded the IOP measurements. RESULTS Mean ± SD IOP measurement before 0.5% timolol maleate instillation measured 13.89 ± 2.29 mmHg. An average reduction 3.75 ± 2.36 mmHg was found with clinician administration, and an average reduction of 3.32 ± 2.31 mmHg was recorded with the new method. No significance was found in IOP reduction between two groups P < .45. Percent reduction was 25.17 ± 16.21% and 24.38 ± 16.31% in clinician instillation and alternative instillation method group, respectively. No significant difference was found. This percentage reduction was similar to previously reported studies. No reported cases of eye infection or irritation were found in any case, within a 3-month follow-up period. CONCLUSIONS We have proposed a more reliable method for instillation that provides a larger area for instillation and lessen the risk of contamination and patient's fear for eye drops. Similar efficacy was found compared with that of having a clinician directly administer the drop. This alternative method could potentially benefit patients who require topical eye drop therapy and result in increased compliance.
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Affiliation(s)
| | | | - Michelle Steenbakkers
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Nadine Furtado
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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The Effect of Patient Education and Telemedicine Reminders on Adherence to Eye Drops for Glaucoma. Ophthalmol Glaucoma 2020; 3:369-376. [PMID: 32980041 DOI: 10.1016/j.ogla.2020.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To determine the improvement in patient adherence to topical ocular hypotensive therapy by introducing a personalized illustrated medication reference chart and telereminder. DESIGN Prospective randomized controlled clinical trial. PARTICIPANTS Fifty-nine patients with glaucoma who were using at least 3 or more eye drops were recruited from the ophthalmology clinic at the National University Hospital of Singapore. METHODS Participants were randomized into 3 groups: control, reference chart only, and reference chart with telereminder. They completed a survey on demographics, barriers to glaucoma medication adherence, and self-adherence (measured by the Morisky adherence scale) before and 6 weeks after intervention. Logistic regression analysis was performed on the barriers that contribute to nonadherence and paired t tests were conducted for the preimplementation and postimplementation effects of intervention on adherence score. MAIN OUTCOME MEASURES Changes in mean adherence score based on the Morisky adherence scale before and after intervention in participants from all 3 groups. RESULTS In our study, 71% of participants who were nonadherent to medications had multiple barriers to adherence, with lack of self-efficacy and forgetfulness being the most common factors. Only the reference chart with telereminder group showed a statistically significant increase in mean adherence score, from 7.18 to 7.69 (P = 0.047). CONCLUSIONS Adherence to medication in chronic diseases like glaucoma is an important healthcare issue to address. Most of these patients have poor adherence because of multiple factors, and hence interventions aimed at improving adherence should be multifaceted to target these barriers.
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Matossian C. Noncompliance with Prescribed Eyedrop Regimens Among Patients Undergoing Cataract Surgery—Prevalence, Consequences, and Solutions. ACTA ACUST UNITED AC 2020. [DOI: 10.17925/usor.2020.13.1.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Taneja M, Chappidi K, Harsha Ch SNS, Richhariya A, Mohamed A, Rathi VM. Innovative bulls eye drop applicator for self-instillation of eye drops. Cont Lens Anterior Eye 2019; 43:256-260. [PMID: 31813766 DOI: 10.1016/j.clae.2019.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/24/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To report the role of Bulls eye drop applicator device in self-instillation of eye drops and in prevention of wastage of medicine. METHODS A small pocket sized device "Bulls eye drop applicator" was developed, which is a simple, handy, mirror-based attachment which can be attached to any eye drop bottle to help in accurate self-instillation of the drops in the eye. The prototype of this device was tried in ten volunteer subjects (Group 1) and 15 patients (Group 2); they were asked to use lubricating eye drops (5 ml bottle) in one eye without the device (N) and in the other eye with the device (M). The numbers of attempts for the application of eye drops were noted and the residual eye drops in the returned bottles were measured for quantitative assessment. RESULTS Ten volunteers and 11/15 patients completed the study. At the completion of the study, there were a total of 232 applications of eye drops in the Group 1 N (without device) and 1 M (with device). To achieve these 232 applications, there were 330 attempts without the device and 266 attempts of instillation were needed with the device (P < 0.0001). In Group 2, there were a total of 544 applications of eye drops; to achieve this, there were 879 attempts in Group 2 N and 685 attempts of instillation in Group 2 M (p < 0.0001). The cumulative quantity of residual drops in the returned bottles collected from Group 2 N was 5.1 ml and it was 19.7 ml in Group 2 M (p = 0.001). CONCLUSIONS The number of attempts of instillation reduced significantly with the use of the eye drop applicator device. The use of eye drops applicator device reduced the wastage of drops from 42.2% to 14.6% in Group 1 N Vs Group 1 M and saving of about 35.7 % in Group 2 M compared to Group 2 N.
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Affiliation(s)
- Mukesh Taneja
- TejKohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India; LVPEI Centre for Innovation, L V Prasad Eye Institute, Hyderabad, India
| | - Kiranmayi Chappidi
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
| | | | | | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Varsha M Rathi
- TejKohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India; Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India.
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The Patient Beyond the Sphincter-Cognitive and Functional Considerations Affecting the Natural History of Artificial Urinary Sphincters. Urology 2019; 137:14-18. [PMID: 31794813 DOI: 10.1016/j.urology.2019.11.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/31/2019] [Accepted: 11/25/2019] [Indexed: 11/21/2022]
Abstract
Artificial urinary sphincters (AUS) are common. Life expectancy at average implantation (71.5 years) is 14 years. During this period patients must still possess manual dexterity and cognitive capabilities needed to operate the AUS, otherwise it is practically unfunctional. Still, available data regarding AUS durability deal with medical and mechanical factors. Issues as age-related deteriorating manual dexterity and cognitive capabilities precluding patients from operating an apparently intact AUS have not been addressed. We set to focus on these aspects. We review the natural history of manual dexterity, physical, and cognitive deterioration of aging men and propose counseling and screening algorithms for evaluating these aspects.
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George NK, Stewart MW. The Routine Use of Intracameral Antibiotics to Prevent Endophthalmitis After Cataract Surgery: How Good is the Evidence? Ophthalmol Ther 2018; 7:233-245. [PMID: 29974362 PMCID: PMC6258587 DOI: 10.1007/s40123-018-0138-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Indexed: 02/06/2023] Open
Abstract
Post-operative endophthalmitis (POE) following cataract surgery is an uncommon, vision-threatening complication that has been reported to occur at rates of between approximately 0.03% and 0.2%. Prompt diagnosis and treatment of endophthalmitis is critical for minimizing vision loss, but most recent efforts have focused on the prophylactic administration of antibiotics to prevent the development of endophthalmitis. Surgeons from around the world have different topical and intracameral antibiotic usage patterns to prevent endophthalmitis, and to date no general consensus regarding best practice has emerged. Several studies have reported on the routine use of intracameral cefuroxime, moxifloxacin, and vancomycin, including a single randomized clinical trial by the European Society of Cataract and Refractive Surgery (ESCRS) in 2007. These studies have notable shortcomings, but many authors suggest that intracameral cefuroxime together with topical antibiotics probably decreases the risk of endophthalmitis. However, the deleterious effects of routine prophylactic antibiotics, which include toxicity, cost, and increasing antimicrobial resistance, among others, are noteworthy. In contrast, aseptic technique with pre-operative instillation of povidone-iodine remains the only technique supported by level I evidence to reduce the incidence of endophthalmitis. Although the routine use of intracameral antibiotics continues to increase throughout the world, data from multicenter, randomized, prospective trials is needed to provide better guidance regarding the prophylactic use of antibiotics.
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Kinast RM, Mansberger SL. Glaucoma Adherence-From Theriac to the Future. Am J Ophthalmol 2018; 191:xiii-xv. [PMID: 29716719 DOI: 10.1016/j.ajo.2018.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/05/2018] [Indexed: 11/19/2022]
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Compliance to topical anti-glaucoma medications among patients at a tertiary hospital in North India. J Curr Ophthalmol 2018; 30:125-129. [PMID: 29988888 PMCID: PMC6033778 DOI: 10.1016/j.joco.2017.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/28/2017] [Accepted: 09/16/2017] [Indexed: 11/20/2022] Open
Abstract
Purpose The present study aims to estimate the prevalence of non-compliance and improper drop administration technique among glaucoma patients and describe common obstacles to medication compliance. Methods A hospital-based cross-sectional study, using standardized questionnaire and direct observation by study personnel was conducted among glaucoma patients aged 18 years and above at a tertiary care charitable eye hospital in North India. 151 consecutive glaucoma patients on medical therapy following up at the glaucoma clinics for at least 6 months were recruited. Non-compliance was defined as missing at-least one drop of medication per week and (or) the inability to accurately describe the medication regimen. Study personnel also assessed drop administration technique during application of eye drops by patients treating ophthalmologist-provided information, including measures of disease stability. Factors such as socioeconomic status, presence of caregiver, and number of medications with their effect on compliance were studied using chi-square statistics. Results Among 151 patients interviewed, around 49% of patients reported problems in using glaucoma medications, with 16% of them reporting total non-compliance. 35% of patients demonstrated improper drop administration technique. Forgetfulness was cited as the main reason for being non-compliant and had a significant association with non-compliance (P = 0.00). Paying patients were more compliant as compared to subsidized patients (P = 0.05). Disease was more stable in compliant patients compared to non-compliant patients (P = 0.05). No other factor had significant association with compliance (P > 0.05). Conclusions Over 50% of the patients surveyed were non-compliant, and 35% demonstrated improper administration technique. Glaucoma patients should be educated on the importance of compliance and aids that minimize forgetfulness, and delivery systems facilitating the delivery of medications to the eye could be considered to enhance patient adherence.
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