Study: About those little PF vials...

Now, you all know how I feel about BAK laced glaucoma drops (and any other Rx drop that anyone is using on a regular basis). At the same time though, I have never believed that the answer could be as simple as making everything in preservative free unit doses instead - for several reasons, including cost and the physical challenge it poses to the elderly - who tend to be the greatest consumers of eyedrops because they have more chronic problems such as dry eye and glaucoma.

This study bears out the latter of those concerns: Only 57% of patients over 80 years old successfully administered drops from single use vials, compared with 89% of 80+ year olds using a bottle and 95% of 50-65 year-olds using PF vials. In my opinion, this underscores the need for less toxic preservatives than BAK and better, more practical preservative-free types of packaging.

Self-application of single-use eyedrop containers in an elderly population: comparisons with standard eyedrop bottle and with younger patients.
Dietlein TS, Jordan JF, Lüke C, Schild A, Dinslage S, Krieglstein GK.
Acta Ophthalmol. 2008 May 20. [Epub ahead of print]

Purpose: To test whether patients aged >/=80 years can safely and successfully apply eyedrops from a single-use eyedrop container without support, and to compare the results with those of younger patients using single-use containers and older patients using standard eyedrop bottles.

Methods: Patients aged >/=80 years who had no physical or mental conditions hindering self-application of eyedrops and actually did so because of glaucoma or dry eyes were included consecutively in the study group (n = 44) in order to perform self-application of eyedrops from single-use eyedrop containers. Patients were observed meticulously by two investigators, who documented practical problems during the procedure in a checklist. In control group A (n = 22), glaucoma or sicca patients aged between 50 and 65 years applied drops from single-use eyedrop containers; in control group B (n = 28), glaucoma or sicca patients aged >/=80 years used a traditional eyedrop bottle.

Results: Successful application of the drops into the conjunctival sac was achieved by 57% in the study group (95% and 89% in control groups A and B, respectively). Scratching of the eyedrop container along the conjunctiva or cornea was observed in 68% of the study group (41% and 61% in control groups A and B, respectively). Frequency of problems during opening and self-application of single-use eyedrop containers in the study group showed an inverse correlation to visual acuity in the better eye and previous experience with this kind of eyedrop container.

Conclusion: Older patients have massive problems in self-administering eyedrops from single-use containers. Factors influencing the success of self-application may include the patient's previous experience with this kind of eyedrop container and the patient's visual acuity.