As any eye-care professional can tell you, a well-known barrier in glaucoma treatment is patient failure to adhere to the prescribed medication regimen. And a major reason for that failure is difficulty in getting the eyedrop into the eye. To counter this, manufacturers offer devices meant to make instillation easier. (see “Eyedrop instillation aids.”)
These devices can be helpful as part of a multi-pronged approach to increase adherence, says those interviewed for this article. Coaching patients in technique remains essential — and technicians can play a crucial role.
When to recommend an aid
Kelly Muir, MD, MHSC, a glaucoma specialist at Duke Eye Center and Durham Veterans Affairs, Durham, NC, says that she recommends the aids to select patients. “It is important to figure out the nature of the issue making drop administration difficult and trouble-shoot with that information,” she explains. “For example, if poor grip strength limits the patient’s ability to squeeze the bottle, AutoSqueeze (MaxiAids) might be helpful. If a tremor makes aiming the drop difficult, then Autodrop (Owen Mumford) might help.
Michael Henry, MD, Northwest Eye Specialists, Tucson, AZ, says his practice sells an aid (Nanodropper, Nanodropper Inc.) that reduces the volume of the drop. “If I hear a patient is always running out of drops early, I bring it up as a possible solution,” he says.
Eyedrop instillation aids
AutoDrop (Owen Mumford). Clamps facilitate the squeezing of the bottle.
AutoSqueeze (MaxiAids). A clamp attaches to the bottle to facilitate squeezing.
Cress Dropper (Wilson Ophthalmic). A flexible arched applicator fits on the ridge of the nose, enabling the tip to apply the drop in the corner of the eye.
Ezy Drop Guide & Eye Wash Cup (AvaCare Medical). A cup fits directly over the eye to facilitate drop instillation.
EZ-Drops Eye Drop Application Strips (E-Z Drops). A reflective strip holds the bottle, enabling the patient to see the reflection of their eye to properly instill the drops.
Eye Drop Helper (Magic Touch). A rubber thimble holds one drop at its tip for instillation.
GentleDrop (GentleDrop). Constructed of non-toxic silicone that fits most conventional eye drop bottles, it rests on the patient’s nose to provide stability and optimize bottle position. According to Dr. Kinast, GentleDrop can expand to fit 5, 10, and 15 ml traditionally shaped bottles. It does not fit 2.5 ml bottles like latanoprost or irregularly shaped bottles like Rohto.
Nanodropper (Nanodropper, Inc.). This FDA-listed bottle adapter reduces the volume of the drop, which helps reduce waste due to overflow, and cost by helping the user get more use out of each bottle.
Opticare Eye Drop Dispenser (Gulden Ophthalmics). A bottle case facilitates grip, squeezing, and drop accuracy. The case’s eyepiece also holds the upper lid to prevent blink reflex.
SimplyTouch (SimplyTouch LLC). A tab holds one drop, which the user touches to their eye for instillation.
The technician’s role
Lenny Muroff, COA and inventor of EZ-Drops reflective strip, notes that it’s the technician who broaches the subject of adherence during the preliminary exam. Standard questions include: Are you taking your eyedrops? How many times per day are you taking them? Are you getting them in your eyes?
Mr. Muroff says that is the perfect time to demonstrate the aids to the patient.
Robert Kinast, MD, at Legacy Health in Portland and creator of the GentleDrop device, agrees. “The most helpful thing an ophthalmic tech can ask is, ‘Do you have difficulty placing eyedrops?’ If patients don’t think they have a problem, they are unlikely to try an aid no matter how clumsy their technique.”
Veronica Plessinger, COMT and clinical director at Eye Care Associates Inc, Portland, OH, notes that even these aids require a dexterity that older patients may not have. Techs at the practice focus on helping patient improve dexterity and creating muscle memory.
“In the exam lane, they train patients or their caretakers with different positions, using the bridge of their noses to steady their hands,” she says.
In addition to in-office training, Dr. Kinast recommends having an at-home coach to make the most of the eyedrop aid as well. “It can be helpful to have a friend watch and provide feedback the first few times using an aid.” OP
