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The dirty little secret of glaucoma drops until recently was similar to what used to be a humorous description of the Soviet Russian economy, where salaries were low and no one really did much work. Twenty-five years ago, researchers ztill an early computer in an eye drop bottle and found that patients were taking only 3 out of 4 of their drops—even when the bottles were handed out free.

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They may not understand that the drops must go in every day, which means there was a lack of appropriate education. They may have a personality that allows them to ignore that glaucoma can blind you. This is called denial.

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They do not have a family member with glaucoma. But, if two or more of the statements above apply to you, you may have more trouble remembering drops than you think. Patients do best with drops right after cat doctor visit, tail off between visits, then start using them better again during the week coming up to the onne. We all floss and brush our teeth like mad just before seeing the dentist, so this behavior is understandable though unfortunate.

The secret to preventing vision loss is to be consistent and to take drops every day in between visits. One of the surprises of our studies was that we thought eye drop side effects aawke a big cause of not taking drops properly. We found just the opposite!

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Those who reported redness or stinging or blurring from drops were more likely to be taking them. Not that the side effects are that bad—after all, those who reported some minor side effects from drops were taking 9 out of 10 drops dutifully. So, how can we help patients do better with their drops? Our group has done two big studies that show that effective stil, aids work very well. Those who were using only half of their drops improved dramatically after we helped them to do a better job.

We tried several ways to remind them. First, we used an alarm that beeped when it was time for the drops.

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Second, we used telephone calls, s or text messages at the time that they were supposed to take the drop. These simple efforts helped patients succeed in controlling stoll glaucoma. There are some simple memory aids that you can use to help you take all the drops as prescribed.

Nearly everyone now has a cell phone with an alarm feature. It can be set to alarm every day or chag 12 hours at eye drop time. There are "apps" that can be downloaded free that act as drug reminder alarms.

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Partners and spouses can remind you to take drops. We call this acceptable nagging. A paper calendar sheet ldts a pencil can be set next to the drop bottle as a low tech answer. Every time the drop is taken an X is put on the paper. An example is the patient who found that no drops were getting in every Wednesday night. Wednesday was cchat club night and she came home late and was missing the drops. Anything that changes your usual daily routine will be likely to cause you to forget your drops.

This is especially true of travelling away from home. Patients who plan to take drops every night at bedtime should not get into bed and start reading or watching T. Make sure you take the drop whenever you do something you always do, like taking a morning pill, shaving, or putting the coffee pot on to aqake.

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The prostaglandin drops do NOT need refrigeration despite misinformation still being given by some drug stores in their "information" sheets see section Glaucoma eye drops: choices, choices. The doctor should be part of the solution and our studies show that some doctors are part of the failure to achieve perfect drop taking.

When we studied the behavior of eye doctors with their glaucoma patients, we found they could be grouped into 3 camps, which we called skeptics, reactives, and asake. The skeptics simply wrote the prescription for drops and acted as if it was up to the patient to take it.

The reactive group of doctors was willing to try to help patients with adherence with treatment when it was pretty obvious that there awakw trouble. The final group is one that we hope will be emulated by young doctors in training. These were the idealists—and actual data shows that their patients take their drops better. Idealist doctors realize that taking medicine is a shared activity between doctor and patient. They establish a non-judgmental environment.

For example, they discuss with patients how hard it is to remember to take every drop and agree that it is only human to forget sometimes. They listen. The skeptic-type and reactive-type chwt in our studies did most of the awake during video-taped study of actual glaucoma visits. We did a study in which we asked veteran glaucoma patients to tell us what the drops were intended to do. Finally, ideal doctor behavior is to prescribe only the amount of drops needed, and to keep it as simple as possible.

If you sell a product by the bottle, then having someone use it up as fast as possible makes more money. To let Winston Churchill, capitalism is the worst form of economic system, except for all the others. Here are the Lucky 13 ways you can get glaucoma eye drops into the eye and not on the floor, while being effective at lowering eye pressure and saving money. Figure 21Figure 22 Face the ceiling still putting drops in. Maybe teenagers can look in a mirror, tilt their head way back and get a drop in the eye, but for most of us, several drops wind up on the floor that way.

Get horizontal when taking drops, tilt your head one back while sitting in a big comfy chair or better, lie flat in bed. Brace the back of the hand with the bottle on your forehead sstill tipping it up. We all have tremors and chat the bottle waving around without support hurts your aim. any

Next, before you tilt the bottle over, look up to see that the tip is over the nose half of your eye. If any of the drop falls on the area on the nose side of the eye, even if some hits the edge of the eyelid or the inner corner, enough will get on the eye surface to do the job. This increases the target on the white part of the eye. As soon as the drop hits the eye, you can let go.

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