Getting Eye Drops From the Bottle into Patients’ Eyes

Pictured above: Paula Anne Newman-Casey, M.D., M.S., Sumukh Marathe, Ph.D. student, Alanson Sample, Ph.D.

Glaucoma is the second leading cause of irreversible blindness in the U.S.—and the leading cause of blindness among African Americans. The standard treatment prescribed to nine in ten glaucoma patients is a daily regimen of eye drops to control their eye pressure.

With this proven, accessible, self-administered, relatively low-cost treatment, why are so many people still losing their sight to glaucoma? Studies report that more than 20 percent of patients do not instill drops properly, and at least 40 percent of the time patients do not keep to the prescribed schedule for using drops. “Patients who fail to use their drops, or use them incorrectly or inconsistently, are more likely to lose vision,” says glaucoma clinician and researcher Paula Anne Newman-Casey, M.D., M.S., Associate Chair for Clinical Research.

“Glaucoma primarily affects older adults, who are more likely to have sensory, fine motor skill and memory deficits, so the numbers should come as no surprise,” she says. “Typically, patients are diagnosed and sent home with a prescription for drops; only one in eight doctors makes any attempt to teach patients how to use them. Clearly, we need to do more to help patients get it right.” Even with coaching, many patients still have difficulty instilling drops.

That’s why Dr. Newman-Casey is a Multi-Principle Investigator of an ambitious project supported by an R01 grant from the NIH/National Institute of Biomedical Imaging and Bioengineering and a Physician-Scientist Award from Research to Prevent Blindness (RPB) to identify and measure each step in getting a drop into an eye by isolating every biomechanical, sensory, coordination and movement factor. “The study takes a page from the playbook of elite athletes and their trainers,” Dr. Newman-Casey explains. “They use sophisticated biomechanical tools to analyze every aspect of performance; the smallest tweak can mean a competitive edge.”

Similar microsensor technologies will be used in motion analyses of study participants who are reflective of the overall population of patients with glaucoma. Participants will be fitted with wearable sensors on the wrist, arm, head and thorax. They will use an eye drop bottle fitted with a special sleeve with additional sensors.

As a participant puts a saline drop in the eye, numerous data points will be captured. “An analysis of the data will give us a picture of whether certain movements predict whether a drop gets in the eye, and will help us determine the most efficient way to predict success,” she says. “A library of instillation profiles could be used to develop coaching strategies personalized to a patient’s particular biomechanical and sensorimotor challenges.”

The project will also evaluate the feasibility and acceptability of cues such as light or sound alarms (also built into the bottle sleeve) and/or telephonic or text message prompts to remind patients to use the drops. Finally, it will assess a method of communicating patients’ eye drop use information to the care team and return feedback and coaching tips to patients.

“We hope all of this learning will inform more effective, personalized strategies to improve patients’ success using all kinds of eye drops,” says Dr. Newman-Casey.

Dr. Newman-Casey credits her team of co-Principal Investigators and colleagues from across UM and halfway around the country, including:

• Stephen Cain, Ph.D., Assistant Professor of Chemical and Biomedical Engineering at West Virginia University and Director of the Advancing Wearable Systems for Out-of-the-lab Measurement and Evaluation (AWeSOME) Research Laboratory will lead the biomechanical analyses of movement as Multi-primary investigator.

• Neuro-physiologist Susan Brown, Ph.D., Associate Professor of Movement Science in the U-M School of Kinesiology and Director of the Motor Control Laboratory, is leading the design of the human movement studies.

• Alanson Sample, Ph.D., Associate Professor of Electrical Engineering & Computer Science and Director of the Interactive Sensing and Computing Lab, is refining the adherence monitor to maximize sensing functionality and energy efficiency.

• David Burke, Ph.D., Professor of Human Genetics in the U-M Medical School, brings critical experience in the development of low-cost health monitoring systems

First row: Suzanne Winter, M.S., Paula Anne Newman-Casey, M.D., M.S., Andrew Droste, M.D., M.S., second row: Susan H. Brown, Ph.D., Alanson Sample, Ph.D., David Burke. Ph.D., back row: Sumukh Marathe, Ph.D. student