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Curr Eye Res. 2019 Jun 11:1-7. doi: 10.1080/02713683.2019.1625405. [Epub ahead of print]

The Association of an Upper Extremity Functional Survey and Glaucoma Medication Administration Success.

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a Department of Medicine , Duke University School of Medicine , Durham , NC , USA.
b Department of Ophthalmology , Duke University School of Medicine , Durham , NC , USA.
c Durham Center for Health Services Research and Development in Primary Care , Durham Veterans Affairs Medical Center , Durham , NC , USA.
d Department of Population Health Sciences , Duke University School of Medicine , Durham , NC , USA.
e Department of Biostatistics and Bioinformatics , Duke University School of Medicine , Durham , NC , USA.


Purpose/Aim: To determine if an upper extremity functional survey may identify which patients will have eye drop administration difficulty. Materials and Methods: Participants with glaucoma treated at a Veterans Affairs Eye Clinic who did not self-report 100% medication adherence were enrolled in a cross-sectional study. Participants were scored on their observed ability to place a drop into the eye (accuracy) and express no more than one drop from the bottle (efficiency). Successful execution of both of these conditions was defined as good drop technique. Participants also completed the QuickDASH, a validated upper extremity functional survey, with higher scores indicating worse disability. We hypothesized participants with lower QuickDASH scores would have an increased probability of observed success with drop administration measures. Diagnoses of upper extremity co-morbidities were abstracted from participants' medical records and clustered into diagnostic groups of either neurologic or musculoskeletal etiologies. Results: When observed, 80 of 94 participants displayed successful accuracy, 58 of 94 participants displayed successful efficiency, and 50 of 94 participants displayed good drop technique. Accuracy with eye drop performance was not related to QuickDASH scores (odds ratio (OR) [probability of successful administration per 10-point decrease in QuickDASH score]: 1.14, 95% CI: 0.89-1.45, p = .29). Success with drop administration efficiency was strongly associated with QuickDASH score (OR: 1.27, 95% CI: 1.04-1.54, p = .02), as was good drop technique (OR: 1.28, 95% CI: 1.05-1.56, p = .01), with lower (better) QuickDASH scores associated with better drop technique. There were no associations between upper extremity neurologic or musculoskeletal co-morbidities and observed good drop technique. The presence of either a neurologic or musculoskeletal upper extremity co-morbidity in a participant's medical record was associated with a higher QuickDASH score. Conclusions: The QuickDASH survey may identify patients with eye drop administration difficulties so this population receives focused drop technique education and management strategies. Abbreviations: CPRS: Computerized Patient Records System; MSK: musculoskeletal; UE: upper extremity; VA: Veterans Affairs.


Glaucoma; functional survey; medication adherence; medication administration

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