Patients with Low Vision Struggle with Placing Eye Drops and Benefit from an Eye Drop Aid

Abstract

To evaluate eye drop self-administration in a low vision patient population and test if a nose-pivoted drop delivery device (NPDD, GentleDropTM, Portland, OR) can improve eye drop delivery in these patients. Repeated-measures case series. Thirty subjects (58 eyes) with low vision, defined as best-corrected visual acuity worse than 20/60 or visual field worse than 20 degrees in the better seeing eye. We video-recorded subjects while self-administering eye drops using their own traditional delivery at baseline, after a standardized teaching, and with a NPDD. Two masked graders independently reviewed each drop delivery. Primary success was defined as the drop reaching the eye without the bottle touching the eye or eyelids. Subjects rated ease-of-use (1-10 scale, 10=easiest) after each drop delivery and completed a satisfaction survey, which included asking whether subjects could place drops independently (1-5 scale, 5=most independent). Logistic-transformed generalized estimating equation (GEE) regression to compare technique satisfaction, ease-of-use, independence, no contact, and success. Primary success was observed in 30 of 58 eyes (52%) at baseline and increased to 44 eyes (76%) with a NPDD (p=0.013). Bottle tip contact occured in 23 of 58 eyes (40%) at baseline and 8 eyes (14%) with a NPDD (p=0.004). Mean ease-of-use scores were 6.7 ± 3.1 at baseline and 8.3 ± 1.8 (p<0.001) with a NPDD. Likewise, the NPDD improved success, bottle tip contact, and ease-of-use compared to post-teaching traditional delivery (p<0.01). Twenty-two of 30 subjects (73%) preferred the NPDD to traditional delivery. Twenty-nine (97%) thought the NPDD was comfortable to use, and all would recommend the device. A subgroup analysis was performed on 16 subjects that self-reported difficulty instilling drops at baseline. The NPDD showed similar results, and it increased confidence in placing drops independently (4.6 ± 0.9) compared to baseline (2.7 ± 1.6, p<0.001). Fifteen (94%) subjects in this subgroup preferred the NPDD. Low vision subjects struggled to self-administer eye drops. A NPDD can improve bottle tip contact, ease-of-use, satisfaction, and independence. Eye care providers could consider screening low vision patients about difficulty with eye drop self-administration and recommending eye drop aids.