Assessment of the instillation technique and the handling of eye drop medications in glaucoma patients attending judo from the month of march to may 2019

Abstract

Aim: The purpose of this study was to assess the instillation technique and handling of anti-glaucoma eye drops in glaucoma patients attending Jimma Medical Center, Department of ophthalmology, southwest of Ethiopia. Method: A hospital based cross sectional study was done on 100 consecutive patients who had been on ocular hypotensive drugs for >6 months. Study subjects were classified under two study groups, based on who actually administered the eye drop; a self-instilling group comprised of 80 respondents and assisted instillation group comprised of 20 respondents. Respondents of the former and attendants of the latter group were asked to demonstrate how they normally instill the eye drops using a bottle of a sterile artificial tear solution. The procedure was observed and video recorded. The parameters studied for the self-instilling group were: age, gender, occupation, place of residence, educational level, duration of eye drop use, provision of previous education on how to use the eye drops, head position of instillation, hand of instillation, time elapsed to instill the first drop, and the mean visual acuity. Parameters used to grade the eye drops instillation technique were the different values of the number of drops instilled, locations where drop(s) landed, any touch to the bottle tip, and eyelid closure or pressure on the lacrimal sac area. Univariate logistic analysis was performed to relate each variable to the eye drop instillation technique, and variables with p<0.05 were included in a multivariate regression model. Finally, the two groups were compared to study the effect of assistance on the performance of the eye drops instillation technique. The eye drops instillation technique and the storage way of the eye drops were, each, studied for association against the level of IOP. Results: The mean age of the 80 self-instilling patients was 58.93 ± 13.12 years. Sixty-four of them had a poor instillation technique. Of these, 16 (25%) had missed the target (globe) and contaminated the bottle tip; 3 (4.7%) had missed the target without bottle contamination; 16 (25%) had instilled the drop(s) on the globe and touched the globe with a bottle tip; 25 (39.0%) had instilled the drop(s) on the globe without touching the globe and contaminated the bottle tip by touching the fingers, eyelids or face; 4 (6.2%) had instilled the drops on the globe without bottle tip contamination and without eyelid closure. The mean score assigned for the eye drops instillation technique was 1.58 + 1.7. This shows that most respondents had practiced a technique that delivered a drop(s) on the globe and contaminated the tip of bottle by touching the eyelids, face, fingers, cloth, and the globe. The mean number of drops squeezed was 1.31. Two or more drops were squeezed by 32.5% of the patients. Nine patients did not squeeze any drop from the bottle. The problem with most respondents was touching of the bottle tip to the fingers, ocular surface, eyelids or face, which occurred in 57 of the 80 (71.2%) self-instilling patients. 4 | P a g e In the multivariate regression analysis, significantly associated factors with a poor technique were increasing age (adjusted OR=9.239, 95% CI 2.356–36.233, p=0.001), and rural dwelling (adjusted OR=6.962, 95% CI 1.229–39.452, p=0.028). Assistance instillation was significantly associated with a good instillation technique (OR=7.429, 95% CI=2.549—21.652, p=0.000). Regarding the parameters of the instillation technique, touching of the bottle tip to the eyelids or face was significantly associated with uncontrolled IOP (adjusted OR=7.24, 95% CI 2.18–23.9, p=0.001). Slight lid closure for more than 1 minute was significantly associated with controlled IOP (adjusted OR=3.16, 95% CI 1.1–9.42, p=0.039). Conclusion: The majority of glaucoma patients had a poor performance regarding self-instillation of their eye drop medications. The age and the place of residence were an independent factor associated with the performance of eye drop instillation. Assistance instillation and slight eyelid closure were both significantly associated with good instillation technique.