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EW GLAUCOMA 88 March 2018 Research highlight by Maxine Lipner EyeWorld Senior Contributing Writer drops once or twice a day,'" Dr. Budenz said, adding that there's no instruction on how to physically put a drop in the eye. He said there are good videos available online, but most doctors don't point patients to such references or take time to demonstrate best practices and make sure patients are instilling drops correctly. This is not like taking a pill, he stressed. "Patients are supposed to wash their hands, tilt their head back, pull the eyelid forward, turn the bottle over, put one drop in without contaminating the tip with their eye, eyelid, or eyelashes, and close their eyes after administration for a few minutes to help with ab- sorption," Dr. Budenz said. "I think that in our elderly patients who may have visual impairment, all of those steps become very challenging, and they haven't even been instructed on them." Included in the study were glaucoma patients who were already on drops. "We videotaped them using a bottle of artificial tears as if they were using their glaucoma drops, then a masked observer examined the tapes and checked if each of the steps was done correct- ly," Dr. Budenz said. In the clinic, patients were randomized to view either a brief educational video on a tablet on proper drop instillation technique or a nutritional video as a control. They were then asked to put in the artificial tear right after- ward, and 1 month later they were videotaped putting in a drop back at their clinic or in their home. Investigators found that be- tween 18.2 and 80% of patients touched the bottle to their eyes or face while instilling a drop, thereby contaminating it, Dr. Budenz report- ed. Also, from 11.3–60.6% of pa- tients did not instill only one drop, and 6.8–37.3% of patients tended to miss the eye with the drop. In addition, proper technique, such as remembering to wash their hands first and closing the eyes after instillation, was not followed in many cases. "We typically tell pa- tients that drops work better if you of his glaucoma patients, who are by and large elderly, have problems physically instilling drops," Dr. Budenz said. Focusing on instillation As part of the study, investigators wanted to look at the specific steps in the drop instillation process and see where patients are deficient to determine if they might be able to improve performance through education. "Glaucoma patients come in, they're given the diagnosis of glaucoma, then they're given a prescription and told, 'Take these Many glaucoma patients find themselves on drops at some point. "Drops are generally the first line treatment in glaucoma, in glaucoma suspects and in ocular hyperten- sives," Dr. Budenz said. "Theoreti- cally, unless providers are starting with laser trabeculoplasty, which is possible but less common, most glaucoma patients are started on drops and continue lifelong." Dr. Budenz was spurred to begin the review study by the work of another practitioner. "Alan Robin [MD] in Baltimore had made the observation in his clinic that many Looking at the process patients use to instill drops H ow deft are patients when it comes to instilling glaucoma drops? Inves- tigators in a recent study published in Current Opin- ion in Ophthalmology took a look at where things stand here, according to Donald Budenz, MD, Universi- ty of North Carolina, Chapel Hill. 1 Among other things, they found that up to 80% of patients contami- nate their eye drop bottle by touch- ing their eye or face, he noted. Glaucoma drops instillation

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