Electronic Monitoring Device May Improve Glaucoma Drop Compliance

Self-instillation of eye drops in patients with glaucoma eyes. An elderly man with glaucoma.
Patients with better adherence have stronger surgical success, and an implant may help confirm compliance.

Patients exhibited high adherence in taking frequent corticosteroid (CS) eye drops after glaucoma surgery when they utilized a remote eye drop monitoring device, according to new research published in Ophthalmology Glaucoma.

Several studies have indicated that, in general, patient adherence for glaucoma eye drop medications is low. Researchers describe The Kali Drop® (Kali Care, Inc.) as a “wireless, 3G-enabled plastic unit that encloses the eye drop bottle and records the date and time of drop administration by sensing inverted bottle position with simultaneous sensor pressure. A charging base logs usage data in real time through the nearest cell phone tower to a remote online server.”

Researchers included 90 eyes of 90 adult patients with open angle or angle closure glaucoma (IOP 15.2±2.7 mm Hg before surgery) who had undergone trabeculectomy, combined trabeculectomy and cataract surgery, or tube shunt surgery at Wilmer Eye Institute from August 2019 to January 2021.

The patients obtained prednisolone acetate 1% from a pharmacy and took it every 2 hours while awake for 1 week, then followed by 4 times daily for 1 week, decreasing daily frequency weekly until 5 weeks post surgery. 

Researchers taught them how to take drops utilizing the Kali Drop device. Overall adherence was 89.7±13.7%. Adherence was 80.9±15.8% (n=83) during q2h and 68.9±14.4% (n=13) in q3h. In q3h, 9 patients had lower adherence compared with the prior week. Mean adherence during tapering was at least 95% per week.

Patients’ self-reported likelihood of nonadherence in a survey suggested mean adherence of 78%, and their predicted performance was a median 11% lower compared with actual performance (P <.0001).

CS consumption was lower compared with the amount prescribed (6.48±1.77 mg vs 7.22±1.87 mg). Six eyes took more drops than prescribed.

Eyes that took closer to ideal dosage were more likely to gain target IOP and avoid reoperation at 6 months or 1 year (P =.05). Older persons, eyes on greater IOP-lowering eye drop classes, and operative eyes with more field loss tended to have worse adherence, multivariable modeling showed. Higher preoperative target IOP was associated with better adherence.

Univariate analysis indicated achieving target IOP at 6 months or 1 year, fewer glaucoma eye drops taken before operation, and better MD were associated with better adherence.

No adverse events related to device or protocol were reported, but 1 patient with low blood pressure was discharged postoperatively, the researchers said.

“Improvements in the technology of electronic eye drop monitoring devices were shown to be practical and to indicate a high level of attempted drop delivery with CS post-operative regimens,” researchers report. 

Limitations of the study include inability to determine success of drop reaching patient’s eye and incomplete data.


McGlumphy EJ, Dosto NO, Johnson TV, et al. Electronically monitored corticosteroid eye drop adherence after trabeculectomy compared to surgical success. Ophthalmol Glaucoma. Published online January 4, 2022. doi:10.1016/j.ogla.2021.12.007