Quantifying and Understanding Glaucoma Eye Drop Medication Instillation and Adherence

项目摘要 尽管有有效的治疗方法，青光眼仍然是不可逆转失明的主要原因。 在非裔美国成年人中，这是导致美国不可逆转失明的第二大原因。 89%的青光眼患者的治疗方法是不坚持每日处方的眼药水，这是一种 青光眼视力丧失的关键可修改驱动因素。在目前的实践中，患者被诊断为青光眼和 只开了一张处方，只有八分之一的开处方的医生教病人如何使用眼药水。 40%的青光眼患者没有按照规定的时间表服用日常眼药水。 20%的青光眼患者滴眼液不成功。青光眼主要影响老年人 可能有与衰老相关的感觉运动缺陷的成年人，这些缺陷损害了成功的药物灌输。我们的 长期目标是开发一个全面的系统来监控药物使用，量化是否 给药滴剂成功交付，将使用数据传达给患者的医疗团队，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 与滴眼液成功相关的生物力学和感觉运动因素--滴入与否 眼睛-我们可以开发更有效的、个性化的干预策略来改善药物治疗 坚持下去，增加灌输成功率。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，以 确定在老年人中成功滴眼液的因素；以及2)使用来自 年长参与者设计全面、简单、人性化的滴眼液依从性监测 系统(EAMS)。EAMS将包括一个低功耗、便携的瓶装传感器和一个蜂窝连接的 通信基站，用于远程识别何时分配眼药水并记录 成功地灌输。EAMS还将整合为个人量身定做的个性化短信程序 遵守级别。在开发之后，我们将测试EAMS以评估EAMS之间的一致性 滴眼液使用事件分类和滴眼成功及滴眼液使用日记和视频- 记录滴眼液。我们将评估该系统在青光眼样本中的可接受性。 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 滴眼液的生物力学及增龄性感觉运动障碍对滴眼液的影响 药物使用。这一知识将有助于开发可扩展的眼药水依从性监测 可用于临床提高青光眼预防视力护理有效性的系统(EAMS) 损失。这一工具将能够在临床和研究中评估眼药水的依从性。 设置。更深入的理解将形成以患者为中心的自我管理支持和援助方法 在结束结果时，青光眼和需要滴眼液药物的所有其他疾病的结果存在差异。

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.