A video study of drop instillation in both glaucoma and retina patients with visual impairment

Am J Ophthalmol. 2011 Dec;152(6):982-8. doi: 10.1016/j.ajo.2011.05.015. Epub 2011 Aug 6.


Purpose: To compare self-administration of drops in both visually impaired glaucoma subjects and retina subjects.

Design: Prospective, observational study.

Setting: Distinct glaucoma and retina practices.

Study population: Subjects with glaucoma or retinal diseases with visual acuity of 20/60 or worse in 1 eye, significant field loss, or both.

Observation procedures: Subjects were video recorded self-instilling a drop onto the worse eye.

Main outcome measure: Proper instillation of eye drop onto ocular surface.

Results: We included 409 subjects (205 glaucoma, 204 retina). Differences between the groups included the following: glaucoma subjects included fewer females (P = .05), included fewer white persons (P < .005), had worse visual acuity (P < .005), had less self-reported arthritis (P < .05), were younger (P < .005), and had more previous exposure to drop use (P < .005). Glaucoma subjects had more bilateral impairment (60% vs 42%; P < .0005). Retina subjects instilled more drops (1.7 vs 1.4; P = .02) and more frequently touched the bottle to the eye (47% vs 33%; P = .003). Of subjects claiming not to miss the eye, nearly one third from each group (P = .32) actually missed. Approximately one third of each group could not get a drop onto the eye (30% retina vs 29% glaucoma; P = .91). Among subjects placing 1 drop onto the eye without touching the adnexae, there was a trend for glaucoma patients to perform better, although both groups did poorly (success, 39% glaucoma vs 31% retina; P = .09).

Conclusions: Among visually impaired subjects, regardless of cause, drop administration was a problem. Both groups wasted drops, contaminated bottles, and had inaccurate perception of their abilities. This has implications for future therapeutic delivery systems.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Antihypertensive Agents / administration & dosage
  • Female
  • Glaucoma / drug therapy*
  • Glucocorticoids / administration & dosage
  • Humans
  • Male
  • Medication Adherence
  • Ophthalmic Solutions / administration & dosage*
  • Prospective Studies
  • Retinal Diseases / drug therapy*
  • Self Administration
  • Surveys and Questionnaires
  • Task Performance and Analysis*
  • Video Recording*
  • Vision Disorders / etiology
  • Visual Acuity / physiology
  • Visually Impaired Persons*


  • Anti-Bacterial Agents
  • Antihypertensive Agents
  • Glucocorticoids
  • Ophthalmic Solutions