Abstract Purpose To assess the ability of a novel imaging device to allow physicians to personalize therapeutic regimens based on objective patient drop administration data. Methods A novel imaging system was used to record video of the drop technique of subjects in clinic (n = 25) or at home (n = 17) for 1 week. Video assessment by a reading center was compared with patient reporting and their prescribed regimen with respect to how many drops were applied and how many landed in the eye. Results Reading center assessment of both drops dispensed and drops landing in the eye was significantly different from the prescribed regimen in the clinic (Pd = 0.005, Pio0.001, respectively) and at-home arms (Pd = 0.003, Pio0.001, respectively). Conclusions This imaging system is a powerful tool to help physicians tailor patient therapy more accurately, to help researchers evaluate new drop therapies with objective rather than subjective data, and to potentially facilitate better patient training for improved drug delivery. Eye (2015) 29, 1383–1391; doi:10.1038/eye.2015.155; published online 11 September 201 Introduction Eye drop medications, both prescription and over the counter, are a mainstay of therapy for treating ocular disorders such as glaucoma. Eye drops are a preferred method of treatment because they are effective, non-invasive, and, in theory, easy to use. However, it is well-known that compliance and getting the eye drop in the eye are significant problems.1–7 Even in cases where a doctor has asked patients direct questions regarding eye drop regimen compliance, and electronic monitoring has been employed, drug delivery failure is still an issue.8–13 Several devices have been developed to help patients adhere to and monitor eye drop regimens,12–15 although none of these techniques for monitoring compliance are meant to determine whether the drops get into the eye; rather they measure if a patient attempts to administer the eye drops. A recent study using video monitoring found that out of the subjects claiming not to miss the eye when applying drops, nearly one-third actually missed; and out of all the subjects, approximately one-third could not get a drop onto the eye at all.5 Another recent study found that only about 9% of patients who use eye drops are able to properly self-administer them.7 Thus, even if patients are reminded about taking their eye drop medication, there still exists a significant number of patients who fail to achieve eye drop delivery that follows their prescribed eye drop regimen. Some patients waste copious amounts of eye drops trying to get the medication into their eyes only to end up with too many or too little drops in their eye.16 Thus, even if the eye drops do make it into a patient’s eye, there is no way to know if the correct dosage was used. This makes it hard for physicians to determine whether their prescribed drug regimen is not working due to an ineffective drug or due to the drop not making it into the eye, which in turn can impact future therapeutic choices. Although direct observation can provide additional information, it is not always an option for patients taking eye drop medications; and even if a direct observer is available to attend all applications of the medication
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