Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
Division of Rehabilitation, University of Yamanashi Hospital, Yamanashi, Japan.
PLoS One. 2021 May 14;16(5):e0251699. doi: 10.1371/journal.pone.0251699. eCollection 2021.
The aim of this study was to investigate the frequency of eyedrop instillation failure and its related physical and visual function factors among glaucoma patients who used hypotensive eyedrops daily.
Patients with a history of self-instillation of one or more ocular hypotensive ophthalmic solutions for six or more months were enrolled. Definitions of instillation failure were eyedrop instillation other than on the eye surface; eyedrop contact with eyelashes; eyedrop bottle tip contact with the eyelashes, eye surface or ocular adnexa; or two or more drops instilled with one instillation trial. To clarify factors related to instillation failure, we used visual function tests and investigated cervical spine extension angles during instillation, pinching strength, physical ataxia (evaluated using the Scale for the Assessment and Rating of Ataxia), motor dysfunction of the upper limbs (evaluated using the Disabilities of the Arm, Shoulder and Hand questionnaire), and vision quality (evaluated using the National Eye Institute Visual Function Questionnaire 25).
Of 103 total subjects, 61.2% satisfied the definition of instillation failure. Instillation of the eyedrop other than at the cul-desac (76.2%) was the most frequent reason for failure, followed by contact of the tip of the eyedrop bottle (22.2%) and instillation of the same or more than two eyedrops in a single attempt (11.1%). Advanced age, a shallow cervical spine extension angle, weak pinching strength, poor motor dysfunction of the upper limbs, the degree of ataxia, poor best-corrected visual acuity, and visual field scores were significant risk factors for instillation failure. Vision quality may have some relation to instillation failure.
It is highly recommended that instillation failure be routinely investigated even among patients with adequate experience using eyedrops and that correct therapies are chosen in a patient-based fashion.
本研究旨在调查每日使用降眼压滴眼液的青光眼患者滴眼失败的频率及其相关的生理和视觉功能因素。
纳入有自我滴注一种或多种眼部降眼压滴眼液 6 个月以上病史的患者。滴眼失败的定义为滴眼液未滴到眼表面；滴眼液接触睫毛；滴眼液瓶尖端接触睫毛、眼表面或眼附属器；或一次滴眼试验滴入两滴或更多滴。为了阐明与滴眼失败相关的因素，我们使用视觉功能测试，并在滴眼时调查颈椎伸展角度、捏力、躯体共济失调（使用共济失调评定量表评估）、上肢运动功能障碍（使用手臂、肩部和手残疾问卷评估）和视力质量（使用国家眼科研究所视觉功能问卷 25 评估）。
在 103 名受试者中，61.2%符合滴眼失败的定义。滴眼于盲袋以外（76.2%）是失败的最常见原因，其次是滴眼液瓶尖端接触（22.2%）和单次尝试滴入相同或更多滴眼剂（11.1%）。高龄、颈椎伸展角度浅、捏力弱、上肢运动功能障碍差、共济失调程度、最佳矫正视力差和视野评分是滴眼失败的显著危险因素。视力质量可能与滴眼失败有关。
即使对于有足够滴眼经验的患者，也强烈建议常规调查滴眼失败情况，并根据患者情况选择正确的治疗方法。
