MAR 10, 2022
Glaucoma
This prospective cohort study used an electronic monitoring tool to measure adherence to topical corticosteroid drops following glaucoma surgery, and to compare adherence rates with target intraocular pressure (IOP) outcomes.
Study design
The use of corticosteroid drops in 90 adults who underwent glaucoma surgery at a single US institution was monitored with the Kali Drop device, a wireless, 3G-enabled unit enclosing the eye-drop bottle that records the time and date of drop administration by sensing the inverted bottle position via simultaneous sensor pressure. The primary outcome measures were adherence to a regimen of eye drops during the first 5 weeks following surgery and achievement of target IOP at 6 weeks, 6 months, and 1 year without the need for additional IOP-lowering surgery or eye drops.
Outcomes
The adherence rate was 89.7% overall, and total adherence rates were better in younger patients and those whose eyes had less field loss. Sex, race, bleb morphology, postoperative pain, and postoperative anterior chamber inflammation did not have significant effects on adherence outcomes. Target IOP was achieved at the final visit (6 months or 1 year) in 80.8% of patients without the need for reoperation.
Limitations
The main limitation was that the eye-drop monitoring device does not measure the actual delivery of steroid to the eye; rather, it is a proxy measure of attempted use. However, there is evidence in the literature demonstrating that successful eye-drop delivery occurs about 83% of the time. In addition, the patients enrolled in the study had over a decade of experience with eye-drop therapy. This may affect the generalizability of results to eye-drop treatment–naïve patients.
Clinical significance
Prior studies have noted modest adherence to topical IOP-lowering drops. It is reassuring that postoperatively, patients with glaucoma have improved adherence to eye-drop therapy. Older patients with advanced glaucoma may require closer follow-up and earlier bleb maintenance interventions to improve surgical success.