Journal List > J Korean Ophthalmol Soc > v.60(2) > 1116299

Shim, Seo, Lee, and Lee: Eye Drop Chart for Improvement of Topical Eye Drops Administration and Adherence



To evaluate the efficacy of an eye drop chart and to determine the factors contributing to adherence enhancement using the eye drop chart.


In this prospective study, enrolled glaucoma patients were educated on the administration of eye drops and use of the eye drop chart. They were required to complete a questionnaire on demographic characteristics and adherence. After 3 months, they completed a second questionnaire on adherence and satisfaction with the use of the eye drop chart. Changes in instillation behavior, relationships between performance scores and demographic characteristics, as well as factors contributing to the improvement of performance scores were analyzed.


Forty-seven patients were enrolled in this study. The performance scores were significantly better for those who administered the eye drops by themselves (p = 0.002), those with an annual income > 60 million won (p = 0.036), and patients with at least a college degree (p = 0.002). After using the eye drop chart for 3 months, the average intraocular pressure was significantly reduced (p = 0.041) and the performance score was improved (p = 0.019). The working area (p = 0.009) and eye drop applicator (p = 0.001) were correlated with performance score enhancement.


The eye drop chart was a cost-effective tool for improving the adherence and instillation practices of glaucoma patients. Adherence was improved among patients with more indoor activity, and those who practiced self-instillation. It is expected that the respective conditions of such patients would be more efficiently improved in a clinical setting.

Figures and Tables

Figure 1

Photographs of Eye- drop chart. (A) Patients can fill in the time and eye-drop name on the front page. (B) The back page provides instructions on eye-drop use with cautions. (C) Actual example of completed eye-drop chart. The drug names and administration times are written above, as shown. Eye-drop chart, when folded as instructed, also plays a role as an eye-drop container.

Table 1

Questionnaire about adherence


NA = not applicable.

Table 2

Demographics and clinical characteristics


Values are presented as number (%) unless otherwise indicated.

SD = standard deviation; IOP = intraocular pressure; MD= mean deviation.

Table 3

Factors attributing performance score at baseline


Values are presented as mean ± standard deviation or number (%).

IOP = intraocular pressure; MD = mean deviation.

*Mann-Whitney U test.

Table 4

Improvement of adherence after applying eye drop chart


EDC = eye drop chart.

*Willcoxon signed ranks test.

Table 5

Comparison of temporal changes in IOP and performance score between groups


Values are presented as mean ± standard deviation or number unless otherwise indicated. ‘Group 1’ means patients whose performance score get worse after three months group. ‘Group 2’ means patients whose performance score get better after three months.

IOP = intraocular pressure.

*Paired t-test.

Table 6

Factors attributing to improvement of performance score


MD= mean deviation; IOP = intraocular pressure.

*Chi-square test (univariate); Multiple logistic regression analysis.

Table 7

Factors attributing to decrease of performance score


MD = mean deviation; IOP = intraocular pressure.

*Logistic regression analysis (univariate); Multiple logistic regression analysis.


This study was made possible with the 2016 SAMSUNG Eye Hospital Grant.

The study was presented as a narration at the 119th Annual Meeting of the Korean Ophthalmological Society 2017 and presented as a poster at the 4th Asia-Pacific Glaucoma Congress 2018.

Conflicts of Interest The authors have no conflicts to disclose.


1. Tatham AJ, Sarodia U, Gatrad F, Awan A. Eye drop instillation technique in patients with glaucoma. Eye (Lond). 2013; 27:1293–1298.
crossref pmid pmc
2. Gaynes BI, Singa RM, Schaab G, Sorokin Y. Impact of administration angle on the cost of artificial tear solutions: does bottle positioning minimize wastage. J Ocul Pharmacol Ther. 2007; 23:196–201.
crossref pmid
3. Ritch R, Jamal KN, Gürses-Ozden R, Liebmann JM. An improved technique of eye drop self-administration for patients with limited vision. Am J Ophthalmol. 2003; 135:530–533.
crossref pmid
4. Kholdebarin R, Campbell RJ, Jin YP, Buys YM. Multicenter study of compliance and drop administration in glaucoma. Can J Ophthalmol. 2008; 43:454–461.
crossref pmid
5. Taylor SA, Galbraith SM, Mills RP. Causes of non-compliance with drug regimens in glaucoma patients: a qualitative study. J Ocul Pharmacol Ther. 2002; 18:401–409.
crossref pmid
6. Olthoff CM, Schouten JS, van de, Webers CA. Noncompliance with ocular hypotensive treatment in patients with glaucoma or ocular hypertension an evidence-based review. Ophthalmology. 2005; 112:953–961.
7. Krilis M, Coroneo M. Digital eye drop instillation--a novel method. Aust Fam Physician. 2013; 42:201–202.
8. Solomon A, Chowers I, Raiskup F, et al. Inadvertent conjunctival trauma related to contact with drug container tips: a masquerade syndrome. Ophthalmology. 2003; 110:796–800.
9. Nelson JD. Corneal abrasion resulting from a unit dose artificial tear dispenser. Am J Ophthalmol. 1987; 103(3 Pt 1):333–334.
crossref pmid
10. Aptel F, Masset H, Burillon C, et al. The influence of disease severity on quality of eye-drop administration in patients with glaucoma or ocular hypertension. Br J Ophthalmol. 2009; 93:700–701.
11. Norell SE. Improving medication compliance: a randomised clinical trial. Br Med J. 1979; 2:1031–1033.
crossref pmid pmc
12. Friedman DS, Hahn SR, Gelb L, et al. Doctor-patient communication, health-related beliefs, and adherence in glaucoma results from the Glaucoma Adherence and Persistency Study. Ophthalmology. 2008; 115:1320–1327.
13. Cooper J. Improving compliance with glaucoma eye-drop treatment. Nurs Times. 1996; 92:36–37.
14. Ashburn FS Jr, Goldberg I, Kass MA. Compliance with ocular therapy. Surv Ophthalmol. 1980; 24:237–248.
crossref pmid
15. Newman-Casey PA, Robin AL, Blachley T, et al. The most common barriers to glaucoma medication adherence: a cross-sectional survey. Ophthalmology. 2015; 122:1308–1316.
pmid pmc
16. Mira JJ, Navarro I, Botella F, et al. A Spanish pillbox app for elderly patients taking multiple medications: randomized controlled trial. J Med Internet Res. 2014; 16:e99.
17. Ho LY, Camejo L, Kahook MY, Noecker R. Effect of audible and visual reminders on adherence in glaucoma patients using a commercially available dosing aid. Clin Ophthalmol. 2008; 2:769–772.
crossref pmid pmc
18. McVeigh KA, Vakros G. The eye drop chart: a pilot study for improving administration of and compliance with topical treatments in glaucoma patients. Clin Ophthalmol. 2015; 9:813–819.
pmid pmc
19. Feng A, O'Neill J, Holt M, et al. Success of patient training in improving proficiency of eyedrop administration among various ophthalmic patient populations. Clin Ophthalmol. 2016; 10:1505–1511.
crossref pmid pmc
20. Sleath BL, Krishnadas R, Cho M, et al. Patient-reported barriers to glaucoma medication access, use, and adherence in southern India. Indian J Ophthalmol. 2009; 57:63–68.
crossref pmid pmc
21. Kaona FA, Tuba M, Siziya S, Sikaona L. An assessment of factors contributing to treatment adherence and knowledge of TB transmission among patients on TB treatment. BMC Public Health. 2004; 4:68.
crossref pmid pmc
22. Brunner-Ziegler S, Rieder A, Stein KV, et al. Predictors of participation in preventive health examinations in Austria. BMC Public Health. 2013; 13:1138.
crossref pmid pmc
23. Dunlop S, Coyte PC, McIsaac W. Socio-economic status and the utilisation of physicians’ services: results from the Canadian National Population Health Survey. Soc Sci Med. 2000; 51:123–133.
crossref pmid
24. Lee SH, Joh HK, Kim S, et al. Income disparities in the use of health screening services among university students in Korea: a cross-sectional study of 2479 participants in a university. Medicine (Baltimore). 2016; 95:e3681.
25. Lee YY, Jun JK, Suh M, et al. Barriers to cancer screening among medical aid program recipients in the Republic of Korea: a qualitative study. Asian Pac J Cancer Prev. 2014; 15:589–594.
crossref pmid
26. Robin A, Grover DS. Compliance and adherence in glaucoma management. Indian J Ophthalmol. 2011; 59:S93–S96.
27. Gupta R, Patil B, Shah BM, et al. Evaluating eye drop instillation technique in glaucoma patients. J Glaucoma. 2012; 21:189–192.
crossref pmid
28. Tsai T, Robin AL, Smith JP 3rd. An evaluation of how glaucoma patients use topical medications: a pilot study. Trans Am Ophthalmol Soc. 2007; 105:29–33.
pmid pmc
29. Ahn DH, Lee YG, Hong YJ. Factors affecting compliance with prescribed eyedrops for glaucoma. J Korean Ophthalmol Soc. 1998; 39:2145–2151.
30. Lee MA, Moon JI, Park MH. Analysis of eye drops applying behavior in glaucoma patients. J Korean Ophthalmol Soc. 2013; 54:1561–1566.
31. Shin HY, Kang HT, Lee JW, Lim HJ. The association between socioeconomic status and adherence to health checkup in Korean adults, based on the Korean National Health and Nutrition Examination Survey. Korean J Fam Med. 2018; 39:114–121.
pmid pmc
Similar articles