Quantifying and Understanding Glaucoma Eye Drop Medication Instillation and Adherence

项目摘要 尽管有有效的治疗方法，青光眼仍然是导致不可逆失明的主要原因 在美国，这是导致不可逆失明的第二大原因。 不坚持每日处方的眼药水-治疗89%的青光眼患者-是一个严重的问题。 青光眼中视力丧失的关键可变驱动因素。在目前的实践中，患者被诊断患有青光眼， 只有八分之一的处方医生教患者如何使用眼药水。 40%的青光眼患者没有按照规定的时间表每天服用眼药水。 20%的青光眼患者无法成功滴入眼内。青光眼主要影响老年人 可能存在与年龄相关的感觉运动缺陷，影响药物滴注成功的成年人。我们 长期目标是开发一个全面的系统来监测药物使用，量化是否 成功地递送所施用的滴剂，将使用数据传达给患者的医疗保健团队，以及 指导每位患者如何使用眼药水。我们的中心假设是，通过识别 与滴眼剂滴入成功相关的生物力学和感觉运动因素-滴入是否成功 眼睛-我们可以开发更有效的，个性化的干预策略，以改善药物治疗 坚持并增加滴注成功率。我们的总体目标是：1）使用运动传感器， 测量滴眼液的生物力学运动，以及感觉运动能力的测试， 确定导致老年人成功滴眼液的因素; 2）使用来自 老年参与者设计一个全面的，简单的，用户友好的滴眼液依从性监测 系统（EAMS）。EAMS将由一个低功耗、便携式、瓶上传感器和一个蜂窝连接的 通信基站，以远程地识别何时滴眼液被分配并且记录滴眼液被分配的概率。 成功的灌输。EAMS还将整合一个个性化的短信程序， 坚持水平。在开发之后，我们将测试EAMS，以评估EAMS之间的一致性 滴眼剂使用事件和滴眼剂滴注成功的分类以及滴眼剂使用日志和视频- 记录滴眼液滴注。我们将在青光眼样本中评估该系统的可接受性 患者通过定性访谈。影响：我们的跨学科团队将获得并分享新知识 关于滴眼液的生物力学和衰老的感觉运动缺陷对滴眼液的影响 药物使用。这些知识将为可扩展滴眼液依从性监测的开发提供信息 系统（EAMS），可用于临床，以提高青光眼护理在预防视力方面的有效性 损失该工具将能够在临床和研究中评估滴眼剂药物的依从性 设置.更深入的了解将告知以患者为中心的自我管理支持和援助方法 缩小青光眼和其他需要滴眼液药物治疗的疾病的疗效差异。

PROJECT ABSTRACT Despite the availability of effective treatments, glaucoma remains the leading cause of irreversible blindness among African American adults and the second leading cause of irreversible blindness in the United States. Non-adherence to daily prescribed eye drop medications – the treatment for 89% of glaucoma patients - is a key modifiable driver of vision loss in glaucoma. In current practice, patients are diagnosed with glaucoma and simply given a prescription, with only 1 in 8 prescribing physicians teaching patients how to use eye drops. 40% of glaucoma patients do not take their daily eye drop medication according to the prescribed schedule. 20% of glaucoma patients do not succeed in getting drops into their eyes. Glaucoma primarily affects older adults who may have aging-related sensorimotor deficits that impair successful medication instillation. Our long term goal is to develop a comprehensive system to monitor medication use, quantify whether administered drops are successfully delivered, communicate usage data to the patient’s health care team, and coach each patient on how to use their eye drop medications. Our central hypothesis is that by identifying the biomechanical and sensorimotor factors associated with eye drop instillation success – whether a drop gets in the eye – we can develop more effective, personalized intervention strategies to improve medication adherence and increase instillation success. Our overall objectives are to: 1) use motion sensors that measure the biomechanical movement of instilling eye drops, together with tests of sensorimotor abilities, to identify factors that result in successful eye drop instillation success among older adults; and 2) use input from older participants to design a comprehensive, simple, and user-friendly Eye Drop Adherence Monitoring System (EAMS). The EAMS will consist of a low-power, portable, on-bottle sensor and a cellular-linked communication base station to identify remotely when an eye drop was dispensed and record the probability of successful instillation. The EAMS will also integrate a personalized text message program tailored to individual adherence levels. Following development, we will test the EAMS to assess the agreement between EAMS classification of an eye drop use event and eye drop instillation success and an eye drop use diary and video- recorded eye drop instillation. We will assess the acceptability of the system among a sample of glaucoma patients through qualitative interviews. Impact: Our interdisciplinary team will gain and share new knowledge about the biomechanics of eye drop instillation and the impact of the sensorimotor deficits of aging on eye drop medication use. This knowledge will inform the development of a scalable Eye Drop Adherence Monitoring System (EAMS) that can be used clinically to improve the effectiveness of glaucoma care in preventing vision loss. This tool will be able to assess adherence to eye drop medications in both the clinical and research settings. A deeper understanding will inform patient-centered approaches to self-management support and aid in closing outcomes disparities in glaucoma – and every other condition needing eye drop medications.