Association of the effectiveness of eye drop self-instillation and glaucoma progression.

Purpose: To evaluate the association between efficacy of self-instillation of eye drops and long-term glaucoma outcomes. Methods: In a previous study, video recordings of eye drop self-instillation by patients with glaucoma or ocular hypertension were graded as Effective or Ineffective depending on whether the patient successfully instilled at least 1 drop on the right ocular surface. Glaucomatous progression was then retrospectively defined as retinal nerve fiber layer (RNFL) thinning as measured by either optical coherence tomography (OCT), visual field (VF) progression or need for incisional glaucoma surgery as determined by a glaucoma specialist unaware of patient performance in the eye drop instillation study. Subjects with at least 2 follow-up OCT or VF studies were included in the current study. Results: The original study enrolled 119 patients. Sufficient follow-up data were available for 101 patients. Eighty-eight patients (87.1%) were Effective in eye drop instillation at baseline. Mean follow-up was 5.1 years, during which time 73 patients (72.3%) had progression or underwent incisional surgery in either eye. A significantly higher proportion of patients in the Ineffective group met the criteria for progression or underwent incisional surgery (Effective: 68.2%; Ineffective: 100%; N = 101; P = 0.017, Fisher’s exact test). Kaplan-Meier survival analyses showed significantly faster time to reaching an endpoint in the Ineffective group (N = 101; P = 0.012, Log-rank test). There was no difference in age, baseline IOP, or baseline RNFL thickness between the groups. Conclusion: Ineffective self-installation of eye drops was associated with an increased risk of glaucoma progression or treatment advancement to incisional surgery.