Smart Electronic Eyedrop Bottle for Unobtrusive Monitoring of Glaucoma Medication Adherence

Breaking Barriers in Behavioral Change: The Potential of Artificial Intelligence-Driven Motivational Interviewing

Patient outcomes in ophthalmology are greatly influenced by adherence and patient participation, which can be particularly challenging in diseases like glaucoma, where medication regimens can be complex. A well-studied and evidence-based intervention for behavioral change is motivational interviewing (MI), a collaborative and patient-centered counseling approach that has been shown to improve medication adherence in glaucoma patients. However, there are many barriers to clinicians being able to provide motivational interviewing in-office, including short visit durations within high-volume ophthalmology clinics and inadequate billing structures for counseling. Recently, Large Language Models (LLMs), a type of artificial intelligence, have advanced such that they can follow instructions and carry coherent conversations, offering novel solutions to a wide range of clinical problems. In this paper, we discuss the potential of LLMs to provide chatbot-driven MI to improve adherence in glaucoma patients and provide an example conversation as a proof of concept. We discuss the advantages of AI-driven MI, such as demonstrated effectiveness, scalability, and accessibility. We also explore the risks and limitations, including issues of safety and privacy, as well as the factual inaccuracies and hallucinations to which LLMs are susceptible. Domain-specific training may be needed to ensure the accuracy and completeness of information provided in subspecialty areas such as glaucoma. Despite the current limitations, AI-driven motivational interviewing has the potential to offer significant improvements in adherence and should be further explored to maximally leverage the potential of artificial intelligence for our patients.

Ethical, legal, and social implications of digital health: A needs assessment from the Society of Behavioral Medicine to inform capacity building for behavioral scientists

The ethical, legal, and social implications (ELSIs) of digital health are important when researchers and practitioners are using technology to collect, process, or store personal health data. Evidence underscores a strong need for digital health ELSI training, yet little is known about the specific ELSI topic areas that researchers and practitioners would most benefit from learning. To identify ELSI educational needs, a needs assessment survey was administered to the members of the Society of Behavioral Medicine (SBM). We sought to identify areas of ELSI proficiency and training need, and also evaluate interest and expertise in ELSI topics by career level and prior ELSI training history. The 14-item survey distributed to SBM members utilized the Digital Health Checklist tool (see recode.health/tools) and included items drawn from the four-domain framework: data management, access and usability, privacy and risk to benefit assessment. Respondents (N = 66) were majority faculty (74.2%) from psychology or public health. Only 39.4% reported receiving "formal" ELSI training. ELSI topics of greatest interest included practices that supported participant engagement, and dissemination and implementation of digital tools beyond the research setting. Respondents were least experienced in managing "bystander" data, having discussions about ELSIs, and reviewing terms of service agreements and privacy policies with participants and patients. There is opportunity for formalized ELSI training across career levels. Findings serve as an evidence base for continuous and ongoing evaluation of ELSI training needs to support scientists in conducting ethical and impactful digital health research.

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.

Review of glaucoma medication adherence monitoring in the digital health era

Current glaucoma treatments aim to lower intraocular pressure, often with topical ocular hypotensive medications. Unfortunately, the effectiveness of these medications depends on sustained patient adherence to regimens which may involve instilling multiple medications several times daily. Patient adherence to glaucoma medications is often low. Recent innovations in digital sensor technologies have been leveraged to confirm eyedrop medication usage in real-time and relay this information back to providers. Some sensors have also been designed to deliver medication reminders and notifications as well as assist with correct eyedrop administration technique. Here, we review recent innovations targeted at improving glaucoma medication adherence and discuss their limitations.

Bluetooth Low Energy Beacon Sensors to Document Handheld Magnifier Use at Home by People with Low Vision

We explored the feasibility of using Bluetooth low energy (BLE) beacon sensors to determine when individuals with low vision (LV) use handheld magnifiers at home. Knowing the frequency and duration of magnifier use would be helpful to document increased magnifier use after successful rehabilitation training, or conversely, to know when someone has abandoned a magnifier and requires assistance. Estimote Sticker BLE beacon sensors were attached to the handles of optical handheld magnifiers and dispensed to eight LV subjects to use at home. Temperature and motion data from the BLE beacon sensors were collected every second by a custom mobile application on a nearby smartphone and transmitted to a secure database server. Subjects noted the date and start/end times of their magnifier use in a diary log. Each of the 99 diary-logged self-reports of magnifier use across subjects was associated with BLE beacon sensor recordings of motion (mean 407 instances; SD 365) and increased temperature (mean 0.20 °C per minute; SD 0.16 °C) (mean total magnitude 5.4 °C; SD 2.6 °C). Diary-logged duration of magnifier use (mean 42 min; SD 24) was significantly correlated with instances of motion (p < 0.001) and rate of temperature increase (p < 0.001) recorded by the BLE beacon sensors. The BLE beacon sensors reliably detected meaningfully increased temperature, coupled with numerous instances of motion, when magnifiers were used for typical reading tasks at home by people with LV.

Inkjet Printed Textile Force Sensitive Resistors for Wearable and Healthcare Devices

Pressure sensors for wearable healthcare devices, particularly force sensitive resistors (FSRs) are widely used to monitor physiological signals and human motions. However, current FSRs are not suitable for integration into wearable platforms. This work presents a novel technique for developing textile FSRs (TFSRs) using a combination of inkjet printing of metal-organic decomposition silver inks and heat pressing for facile integration into textiles. The insulating void by a thermoplastic polyurethane (TPU) membrane between the top and bottom textile electrodes creates an architectured piezoresistive structure. The structure functions as a simple logic switch where under a threshold pressure the electrodes make contact to create conductive paths (on-state) and without pressure return to the prior insulated condition (off-state). The TFSR can be controlled by arranging the number of layers and hole diameters of the TPU spacer to specify a wide range of activation pressures from 4.9 kPa to 7.1 MPa. For a use-case scenario in wearable healthcare technologies, the TFSR connected with a readout circuit and a mobile app shows highly stable signal acquisition from finger movement. According to the on/off state of the TFSR with LED bulbs by different weights, it can be utilized as a textile switch showing tactile feedback.

Is laser trabeculoplasty the new star in glaucoma treatment?

PURPOSE OF REVIEW

For decades, laser trabeculoplasty has been a well-proven therapeutic option in glaucoma management, and more recently, it has only gained in popularity. One reason for such popularity is that selective laser trabeculoplasty (SLT) is a therapy independent of patient adherence, which is typically low among glaucoma patients. Consequently, the number of studies on SLT has multiplied throughout the past years. This review provides an overview of studies on SLT from the last 12 months.

RECENT FINDINGS

The studies on treatment outcome show a wide range of success rates of SLT reaching between 18 and 88%; however, study designs differ and many studies are not directly comparable. The prospective laser trabeculoplasty for open-angle glaucoma and ocular hypertension (LiGHT) trial has demonstrated good efficacy of SLT - 75% of the eyes achieved their target pressure without drops and 58% after a single SLT.

SUMMARY

SLT has proven to be effective in lowering IOP with satisfactory success rates even after single SLT. SLT is repeatable independent of patient's adherence.

Improving Adherence to Topical Medication in Patients with Glaucoma

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.