When the Eye Drops Don’t Go In

    For drop-based glaucoma treatment to be effective, the patient must adhere to the dosage regimen and apply the medication correctly. The problem is that this doesn’t always happen. Drops are often installed improperly, not used, or not taken according to the prescribed regimen.

    Improper installation of drops can be a huge waste of money. One study in the Journal of Glaucoma reported that patients who used eye drops incorrectly were prescribed more bottles. Of course, that makes sense. If a patient doesn’t hit the eye the first time around, he or she will try again. The trouble is that the patient could put in too much or too little the second time. That can lead to problems ranging from irritation around the eyes to poor intra-ocular pressure control. (This problem is especially widespread in older and arthritic patients, who have trouble gripping small bottles. This is why Gulden sells the Opticare Eye Drop Dispenser, which is designed to augment the size of small eye drop medication bottles and facilitate delivery of the drop).

    Of course, even when a patient does everything correctly, there can still be problems. In 1979, timoptic became the first beta-blocker approved for lowering intra-ocular pressure. Soon after, older patients were having problems, such as dizziness, fatigue, severe asthma attacks. In addition, there was the masking of hypoglycemia in diabetics so that the typical warning signs of tremors, sweating and palpitations were not experienced. Then in the 1990’s the prostaglandin analog latanoprost came along. This medicine had fewer side effects, so it became the go-to eye drop for glaucoma patients.

    Even with a medicine with fewer side effects, however, there can still be problems. It has been found that if a patient is using a topical steroid such as prednisolone acetate, a spike in pressure was seen two weeks into drug therapy. Why? Well, because patients weren’t shaking the medicine bottle enough times to get the contents mixed properly. (This medicine needs to be shaken vigorously 20 times before each application so that the right dose gets in the patient’s eye.)

    Over time, new topical steroids came out, like Durezol and Lotemax, which don’t require any shaking. While it is good that there are now medicines that take into account the fact that the average person isn’t an expert in administering medicine, patient education still needs to be done. The clinician should be sure to demonstrate how to put the drops in so that the proper amount of medicine gets in the patient’s eye. If necessary, recommend (or sell) a tool such as the Opticare dispenser. Since eye drops seem so simple, it is easy to let patient education go by the wayside. Still, a little demonstration goes a long way in helping patients get the most out of their medicine and ultimately maintain good eye health.