Evaluation of a New Method for Instilling Eye Drops

PURPOSE: The purpose of this project is to test an alternative method for instilling eye drops. The new method involves the patient self-administer the eye drop onto the skin of their medial canthus, with the lids gently closed, and then open the lids once the "cold and wet" sensation of the eye drop is felt along the margins of the closed lids. We will compare the physiological and therapeutic efficacy of instilling the same eye drops into the eyes of the same subjects, using two methods. The first will be to have the eye drop administered using the "gold standard" method employed by optometrists to instill eye drops in the office. The second will be to employ the new method of self-administration described above. HYPOTHESIS: Instillation of an eye drop, over the gently closed lids at the medial canthus, has the same physiological effect and therapeutic efficacy as a drop of the same agent, at the same concentration, properly applied onto an open eye by a trained professional. Aim #1: Determine if there is a difference in efficacy between drops of 0.5% timolol maleate administered by a professional, using the standard clinical method versus patient self-administration using the newly proposed method, in NORMAL SUBJECTS. Aim #2: Determine if there is a difference in efficacy between glaucoma drops administered by a professional, using the standard method versus with patient self-administration of the same drop, using the newly proposed method, in GLAUCOMA PATIENTS. JUSTIFICATION: While new drug development in the glaucoma field seeks to address the issue of the difficulty patients experience with self-administration of an eye drop by pressing for new drugs that show efficacy in a once daily dosing routine, this strategy has potentially serious negative consequences. Clearly, when glaucoma medications are administered only once a day, if the patient misses their eye on that single instillation, the period of lapsed treatment is 24 hours or more. If their disease worsens, either due to non-compliance with their treatment regimen or inability to instill an eye drop, they will require more follow up visits, additional medications, additional diagnostic tests, and earlier surgery. In this regard, the consequences of non-compliance or inability to comply are the same - increased blindness from glaucoma and increased costs associated with trying to prevent this blindness in needlessly advancing disease. OBJECTIVES: The objective of this proposal is to test the therapeutic efficacy of an alternative method of instilling eye drops. This requires comparing the effects of the same volume of the same drug, applied using the classical method and the new alternative method. If the proposed study is successful, a more reliable method for instilling drops of all kinds, to all patients, will have been validated.