Compliance with ocular therapy

doi:10.1016/0039-6257(80)90045-4

Survey of Ophthalmology

Volume 24, Issue 4, January–February 1980, Pages 237-248

https://doi.org/10.1016/0039-6257(80)90045-4 Get rights and content

Abstract

Patient noncompliance with the physician's prescribed therapeutic regimen can present serious obstacles both to individual patient care and to the obtaining of information necessary for controlled drug trials. Unfortunately, the physician often is unable to determine whether and to what extent a patient is not complying with therapy. This article reviews the problem of patient noncompliance with particular emphasis on how and why noncompliance occurs, and methods of predicting, detecting and coping with the defaulting patient.

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Cited by (69)

Determining initial ocular comfort differences between 0.7% olopatadine and 0.035% ketotifen fumarate
2023, Contact Lens and Anterior Eye
Citation Excerpt :
This study likewise found that neither drop posed any negative changes to vision or ocular redness during this same timeframe. The literature suggests that between 25% and 50% of patients are not compliant with their medication regimens, and one reason that patients are more likely to adhere to their regimen is if there is a reduction of medication-induced side effects, such as improved comfort upon application [11,18]. While there are multiple factors that contribute to good patient medication compliance (e.g., effectiveness, cost, ease of use, comfort), the data from the current study suggest that 0.7% olopatadine drops provide superior initial comfort compared to 0.035% ketotifen fumarate drops, which in turn may increase compliance in some patients.
To compare the ocular comfort at application of topical, over-the-counter, 0.7% olopatadine and 0.035% ketotifen fumarate anti-allergy eye drops.
This study recruited participants who were minimally symptomatic based upon Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire scores (≤3 units) and who had minimal between-eye inter-ocular comfort differences as judged by visual analog scale scores (VAS; ≤7 units). Baseline comfort was evaluated by eye with a VAS. One drop of 0.7% olopatadine or 0.035% ketotifen fumarate was then applied to the right eye with the alternative drop being immediately applied to the left eye. Participants were next evaluated with the same comfort VAS by eye at drop application, and then at 30 s, 1 min, and 2 min post-application. LogMAR visual acuities and bulbar conjunctival redness were evaluated pre- and post-drop application to judge initial changes.
This study enrolled 159 participants who had a mean ± SD age of 26.3 ± 7.7 years, and 78.6% of the participants were female. The VAS found that the 0.7% olopatadine drop was more comfortable than the 0.035% ketotifen fumarate drop at all time-points. There were no between-eye differences in LogMAR visual acuities, yet bulbar redness was significantly less in 0.7% olopatadine treated eyes compared 0.035% ketotifen fumarate treated eyes.
This study found that topically applied 0.7% olopatadine drops were initially more comfortable than 0.035% ketotifen fumarate drops.
History
2019, Contact Lenses
Mirror-hat device as a drop delivery aid: A pilot study
2014, Canadian Journal of Ophthalmology
Citation Excerpt :
These results indicate that the mirror-hat aid may help in reducing contamination of the bottle tip and improve visualizing the drops. Previous studies1,2,10,11,13–15 have reported that in 3% to 40% of subjects the drop misses the eye and almost always 2 drops are needed to achieve a successful application. Missing the eye may result in disease progression from missed drops and dermatitis from drops contacting the skin.23
To evaluate the effectiveness of a novel mirror-hat drop delivery aid.
Prospective, observational study.
Sixty eyes from 30 subjects with primary open-angle glaucoma or ocular hypertension attending the glaucoma unit at the Toronto Western Hospital.
The mirror-hat device consists of a magnifying mirror attached to a brimmed cap. The aid was provided to subjects who self-administered topical antiglaucoma medications. Drop instillation technique (time taken to instill a drop, number of drops dispensed, drop contact location, and contamination of bottle tip) was evaluated with and without the device. Subjects also completed a survey regarding drop administration and satisfaction with the device.
Subjects were less likely to contaminate the bottle tip by touching their eye/eyelid when using the device than without the device (13% vs 37%, respectively, p = 0.02). Twenty-six subjects (86.7%) indicated they could see the drop using the device versus 12 (40%) who reported they saw the drop without the device (p = 0.0005). There were no statistically significant differences in any of the other outcomes. No predictive factors were associated with improved drop administration technique while using the device including uncorrected near-visual acuity, lens status, and glaucoma severity.
Use of the mirror-hat aid is associated with significantly less bottle-tip contamination and better visualization of the drop than without the device; however, the device did not help to reduce time, number of drops, or accuracy when administering eye drops.
Évaluation de l’efficacité d’aide-goutte d’un chapeau innovateur muni d’un miroir.
Étude d’observation prospective.
Soixante yeux de trente sujets qui, ayant un glaucome primaire à angle ouvert ou une hypertension oculaire, fréquentaient la clinique de glaucome de l’hôpital Western de Toronto.
L’appareil du chapeau à miroir comporte un miroir grossissant fixé à la bordure d’un couvre-chef. L’aide a été fourni à des sujets qui s’administraient eux-mêmes les médicaments topiques anti-glaucomes. La technique d’instillation des gouttes (le temps requis pour instiller une goutte, le nombre de gouttes administrées, l’emplacement du dépôt de la goutte et la contamination de l’embout du flacon) a été évaluée avec et sans appareil. Les sujets ont aussi rempli un questionnaire concernant l’administration de la goutte et leur satisfaction de l’appareil.
Les sujets ont été moins enclins à contaminer l’embout du flacon en touchant leur œil ou leur paupière en utilisant l’appareil plutôt que sans l’utiliser (13 vs 37 % respectivement (p = 0,02). Vingt-six sujets (86,7 %) ont indiqué qu’ils pouvaient voir la goutte avec l’appareil alors que 12 (40 %) ont dit voir la goutte sans l’appareil (p = 0,0005). Il n’y avait pas d’écarts statistiquement significatifs dans aucun des autres résultats. Aucun facteur prédictif n’a été associé à l’amélioration de la technique d’administration des gouttes par l’utilisation de l’appareil, comprenant l’acuité visuelle de près non corrigée, l’état de la lentille et la gravité du glaucome.
Le recours à l’aide du chapeau à miroir est associé à moins de contamination de l’embout du flacon et à une meilleure visualisation de la goutte que sans l’appareil, toutefois l’appareil n’a pas aidé à réduire le temps, le nombre de gouttes ni leur précision lors de leur instillation oculaire.
Videotaped evaluation of eyedrop instillation in glaucoma patients with visual impairment or moderate to severe visual field loss
2010, Ophthalmology
Objectively evaluate the ability of visually disabled glaucoma patients to successfully administer a single drop onto their eye.
Prospective, observational study.
Experienced glaucoma patients with Early Treatment of Diabetic Retinopathy Study visual acuity (VA) of ≤6/18 (≤20/60) ≥1 eye, or moderate or severe visual field damage in ≥1 eye.
Subjects were “low vision” (20/60 ≤VA <20/200) or “blind” (light perception <VA ≤20/200). They completed a survey about eyedrop use, and were video-recorded instilling 1 drop into their worst-seeing eye in their usual fashion, using a 5-ml bottle.
Successful instillation of a single drop.
Of 204 glaucoma subjects (55% female; 74% Caucasian; 89% primary open-angle glaucoma; mean age, 68.8±13.1 years), 192/204 (94%) used drops >6 months. Subjects used a mean of 1.9±1.1 bottles of intraocular pressure-lowering medications to treat their glaucoma. Seventy-six percent (155/204) of subjects had severe visual field damage, with a mean deviation of −14.5±8.0. Twenty-six percent (54/204) had acuity of ≤20/200 in ≥1 eye, and subjects had a mean logarithm of minimal angle of resolution acuity of 0.8±0.9. Seventy-one percent of subjects were able to get a drop onto the eye; only 39% instilled 1 drop onto the eye without touching the ocular surface, instilling a mean 1.4±1.0 drops, using 1.2±0.6 attempts. Of the 142 subjects who denied touching the bottle to the ocular surface, 24% did touch the bottle to the eye. Multiple factors were tested for ability to predict successful application of an eyedrop; however, only age (<70 vs ≥70 years) was found to be a significant predictor for less successful instillation.
In this video analysis of visually impaired glaucoma patients, we evaluated the difficulty this population has instilling eyedrops, most important, the use of multiple drops per instillation, potential contamination of a chronically used bottle, and poor patient understanding of the situation. Ability to self-administer eyedrops and cost considerations of wasted drops must be thought out before institution of glaucoma therapy. Efforts to determine better methods of eyedrop administration need to be undertaken.
Proprietary or commercial disclosure may be found after the references.
Medical treatment of glaucoma: General principles
2009, Becker-Shaffer's Diagnosis and Therapy of the Glaucomas: Eighth Edition
Perceived Stress Levels and Associated Factors in Adult Patients with Primary Open-angle Glaucoma: A Prospective Survey Study
2022, Korean Journal of Ophthalmology

View all citing articles on Scopus

^☆: This study was supported in part by grant number EY 00336 from the National Eye Institute, Bethesda, Maryland, and by a grant from Fight for Sight, Inc. (Dr. Goldberg), New York, New York.

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Therapeutic reviewCompliance with ocular therapy☆

Abstract

Fertil Steril

J Pediatr

Lancet

Soc Sci Med

J Chron Dis

J Am Pharmaceut Assoc

Lancet

J Chron Dis

Tubercle

J Chron Dis

J Pediatr

Pediatr Clin North Am

J Am Pharmaceut Assoc NS

Lancet

J Am Pharmaceut Assn

J Chron Dis

Patients and prescriptions: Comprehension and compliance with medical instructions in a suburban pediatric practice

Clin Pediatr

Summary of discussions and recommendations related to compliance

Sociobehavioral determinants of compliance with health and medical care recommendations

Med Care

Compliance with a medical regimen for asthma: A test of the health belief model

Public Health Rep

Patient acceptability of two diuretic/potassium supplement preparations

J Int Med Res

Failure of children to receive penicillin by mouth

New Engl J Med

Tuberculosis patients treated at home

Am Rev Resp Dis

Self-medication behavior as measured by urine chemical tests in domiciliary tuberculosis patients

Am Rev Resp Dis

A comparison of patient compliance in treated vs untreated ocular hypertension

Trans Am Acad Ophthalmol Otolaryngol

Patient compliance

New Engl J Med

Treatment adherence

Br J Psychiatry

Patient compliance in glaucoma

Br J Ophthalmol

People who accompany alcoholics to the hospital as a predictor of patient drop-out

Hosp Community Psychiatry

Drug defaulting. I: Determinants of compliance

Am J Hosp Pharm

Drug defaulting. II: Analysis of non-compliance patterns

Am J Hosp Pharm

Propranolol in hypertensive dialysis patients: efficacy and compliance

Clin Pharmacol Therapeut

Problems in prescribing for ambulatory black children

S Afr Med J

Patients' cooperation with a medical regimen

JAMA

Medical recommendations — followed or ignored? Factors influencing complications in arthritis

Arch Physiol Med Rehabil

Compliance and prescribance

Am J Dis Child

How well do patients take oral penicillin? A collaborative study in private practice

J Pediatr

Results of the PAS urine test (Phenistix) study done in May and June, 1959

Am Rev Resp Dis

Drug-taking compliance: A review and synthesis

Health Serv Res

Parent attitudes toward participation of their children in polio vaccine trials

Am J Pub Health

Penicillin treatment of streptococcal pharyngitis

JAMA

Some relationships between social class and practice of dynamic psychotherapy

Am J Psychiatry

Patient compliance with medical advice

J Natl Med Assoc

A study of characteristics of patients who fail to complete a VA alcoholic treatment program

Rehabil Lit

Predicting attrition during the out-patient detoxification of narcotics addicts

Med Care

Variations in patients' compliance with doctors' orders: Analysis of congruence between survey responses and results of empirical investigations

J Med Ed

Predicting non-compliant behavior

J Health Soc Behav

Variations in patients' compliance with doctors' advice: An empirical analysis of patterns of communication

Therapeutic review
Compliance with ocular therapy☆