Improving eye drop adherence: a simple technique using a cable tie.

Abstract

Given that eye drops are the mainstay of treatment for many eye conditions, the importance of administering them correctly is self-evident. However, eye drop compliance remains an ongoing challenge within ophthalmology. Deokule et al. (2004) found only 52% of glaucoma patients could name their medication or frequency of instillation correctly. Instilling the correct number of drops each day becomes particularly challenging for patients on complicated drop regimens, as individuals using three or more bottles of eye drops are five times less likely to recall their medications (O'Hare et al. 2009). Here, we describe a novel technique developed by a patient to improve eye drop compliance. A brightly coloured cable tie is placed around the eye drop bottle and tightened, and the excess is trimmed. Evenly spaced marks are then drawn on the side of the bottle according to how many times the eye drop needs to be administered each day (Fig. 1A). At the start of the day, the cable tie should be located at the top of the bottle. As each set of eye drops is administered, the cable tie is slid down to the next mark, reaching the bottom mark by the end of the day (Fig. 1B). A cable tie at the bottom of the bottle indicates that all drops for the day have been administered. If there is room on the bottle, the scheduled time of each dose can be written next to the corresponding line. The bottle is placed in a prominent position in the home to act as its own visual reminder. The position of the cable tie instantly informs the patient of how many drops are still due to be administered. At the end of the day, the cable tie is reset back to the top of the bottle. This simple technique is inexpensive, elegant and informs the patient of the doses left to be administered with just a quick glance. It is particularly helpful for patients with short-term forgetfulness who struggle to recall if they did or did not administer their drop. The cable tie can be fastened in clinic or by a family member, and thereafter, the system requires minimal dexterity to operate. It may be useful for patients with chronic ocular conditions such as glaucoma, in the postoperative setting and in the treatment of infective or inflammatory conditions where eye drops are typically required many times a day. Existing strategies to improve eye drop adherence include digital alarms, dose calendars and associating drop use with daily activities. Each technique has its limitations, and there is insufficient evidence to advocate any particular method over others (Waterman et al. 2013). Electronic medication alarms have been shown to increase adherence rates (Boden et al. 2006; Kahook 2007), but these can be expensive, fragile and complicated to manage when multiple medications are required. Patients may find our cable tie technique easier than setting digital alarms or drawing a dosing calendar. A potential downfall of our technique is that it does not give the patient a prompt to actually administer the drops at the correct time, so a reminder system such as an alarm may still be required for some patients. In summary, this technique is a helpful tool that eye care practitioners can recommend to their patients to support eye drop compliance.