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Editors Selection IGR 17-4

Medical therapy: Compliance monitor

Comment by Darrell WuDunn on:

13993 Microprocessor controlled compliance monitor for eye drop medication, Hermann MM; Diestelhorst M, British Journal of Ophthalmology, 2006; 90: 830-832

Find related abstracts

Assessing adherence with topical glaucoma therapy has been a challenge for clinicians and researchers. Electronic monitoring devices that are incorporated into or attached to medication bottles have generally been found to be superior to patient questionnaires, insurance claims data, pharmacy data, and physician assessments. However the only commercially-available monitoring device is limited to specific bottles of one pharmaceutical company. Hermann and Diestelhorst (893) have developed a promising new microprocessor-controlled monitoring device that attaches to a conventional eye drop container. A flexible foil pressure sensor wraps partly around the bottle and measures the force applied to the squeezing bottle. A vertical position sensor determines if the bottle is tilted when being squeezed. The authors investigated its accuracy by mounting the device beneath ten 10 ml bottles containing artificial tears and having ten volunteers instill 15 drops over a 3-day period and manually record each instillation. The ten devices recorded 149 of 150 manually-documented instillations (99% sensitivity). Two of the devices recorded 3 extra instillations not manually documented (98% specificity). The authors conclude that their device demonstrated high reliability. The device does have limitations. It adds significant height to the bottles (about 20 mm) and patients are certainly aware of the device. Its battery lifetime exceeded 60 days but that may be inadequate for routine follow-up intervals of glaucoma patients. In addition, three days of testing with volunteers is insufficient to test its durability under real-life patient conditions. Furthermore, ease of data retrieval and cost considerations, including who will pay for such a device, may affect the likelihood of adoption. Limitations aside, this device holds potential for assessing adherence. That it can be configured with multiple containers should broaden its appeal. However, further refinement and testing, involving real patients, are still needed before the device is ready for widespread use.

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