Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Topical medication instillation techniques for glaucoma

Information

DOI:
https://doi.org/10.1002/14651858.CD010520.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 20 February 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:

  1. Cochrane Eyes and Vision Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Article metrics

Altmetric:

Cited by:

Cited 0 times via Crossref Cited-by Linking

Collapse

Authors

  • Li Xu

    Correspondence to: Hainan Provincial Key Laboratory of Ophthalmology, Hainan Eye Hospital, Zhongshan Ophthalmic Center, Haikou, China

    [email protected]

  • Xuemei Wang

    Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

  • Meijing Wu

    Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA

Contributions of authors

  • LX developed, designed, and wrote the protocol. XW and MW provided feedback on the protocol.

  • Conceiving and designing the review: LX.

  • Designing and undertaking search strategies: Lori Rosman (Cochrane Eyes and Vision (CEV)).

  • Screening search results: LX, XW, MW, CEV.

  • Organizing retrieval of papers: LX.

  • Screening retrieved papers against inclusion criteria: LX, XW, MW.

  • Appraising risk of bias: LX, XW, MW, CEV.

  • Extracting data from papers: LX, XW, MW.

  • Writing to authors of papers for additional information: LX.

  • Entering data into Review Manager 5: LX, XW, MW.

  • Analysis of data: LX, XW, MW.

  • Interpretation of data:

    • providing a methodological perspective: LX, XW, MW, CEV;

    • providing a clinical perspective: LX, XW, MW;

    • providing a consumer perspective: LX, XW, MW.

  • Writing the review: LX, XW, MW.

Sources of support

Internal sources

  • Johns Hopkins University, Baltimore, Maryland, USA.

External sources

  • Methodological support provided by the Cochrane Eyes and Vision US Satellite, which is funded by the National Eye Institute, National Institutes of Health, Grant 1 U01 EY020522, USA.

  • National Institute for Health Research (NIHR), UK.

    • Richard Wormald, Co‐ordinating Editor for Cochrane Eyes and Vision (CEV) acknowledges financial support for his CEV research sessions from the Department of Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology.

    • The NIHR also funds the CEV Editorial Base in London.

    The views expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS, or the Department of Health.

Declarations of interest

LX: none known.
XW: none known.
MW: none known.

Acknowledgements

We acknowledge Cochrane Eyes and Vision (CEV) for assisting with the preparation of this review. We thank Lori Rosman, Information Specialist for CEV@US, for developing and executing the electronic search strategy. We thank Scott Davis, Barbara Hawkins, and the CEV editors for comments.

Version history

Published

Title

Stage

Authors

Version

2017 Feb 20

Topical medication instillation techniques for glaucoma

Review

Li Xu, Xuemei Wang, Meijing Wu

https://doi.org/10.1002/14651858.CD010520.pub2

2013 May 31

Topical medication instillation techniques for glaucoma

Protocol

Li Xu, Xuemei Wang, Meijing Wu

https://doi.org/10.1002/14651858.CD010520

Differences between protocol and review

We added the assessment of the certainty of evidence using the GRADE approach and a 'Summary of findings' table to the review methods. The 'Summary of findings' table was not part of the original Cochrane protocol, thus the selection of outcomes presented in the table was made post hoc. We based our selection on core outcomes for glaucoma research that have been proposed in the literature (Ismail 2016).

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Navigate to figure in ReviewOpen in new tab

Risk of bias summary: review authors' judgments about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgments about each risk of bias item for each included study.

Navigate to figure in ReviewOpen in new tab
Summary of findings for the main comparison. Topical medication instillation techniques for glaucoma

Topical medication instillation techniques for glaucoma

Population: participants with glaucoma or ocular hypertension

Settings: ophthalmology clinics

Intervention: any intervention aimed to increase effectiveness or reduce adverse events when using topical medications (e.g. eyelid closure, nasolacrimal occlusion, removal of excess fluid after instillation)

Comparison: no intervention

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

No intervention

Instillation intervention

Proportion of participants with IOP < 21 mmHg

at 1 year' follow‐up

Not reported

‐

Mean IOP change from baseline

at 1 year' follow‐up

Not reported

1 trial reported that reduction of IOP was similar in eyes when the eyelid was kept closed for up to 3 minutes after instillation of drops than fellow eyes that did not practice eyelid closure at 2 weeks (MD ‐0.33 mmHg, 95% CI ‐0.8 to 1.5; 51 participants); moderate‐certainty evidence.1

Participant‐reported outcomes related to the ease, convenience, and comfort of instillation

at 1 year' follow‐up

Not reported

‐

Physiologic measurements of systemic absorption

at 1 year' follow‐up

Not reported

‐

Escalation of therapy

at 1 year' follow‐up

Not reported

‐

Mean change in visual fields

at 1 year' follow‐up

Not reported

‐

Adverse events

at 1 year' follow‐up

Not reported

1 trial with up to 4 months' follow‐up reported that eyelashes were shorter among eyes when participants had wiped to remove excess fluid compared with fellow eyes that were not wiped (MD ‐1.70 mm, 95% CI ‐3.46 to 0.06; 10 participants) and fewer eyes had eyelash growth of > 1.5 mm when wiping compared with not wiping (RR 0.11, 95% CI 0.01 to 1.24); low‐certainty evidence.1,2

This same trial also reported that fewer eyes showed skin hyperpigmentation in the eyelid region towards the nose when wiping compared with not wiping (RR 0.07, 95% CI 0.01 to 0.84); however, the difference was not certain when assessing skin hyperpigmentation in the eyelid region towards the temples (RR 0.44, 95% CI 0.07 to 2.66) or hair growth on the skin around the eye (RR 1.00, 95% CI 0.17 to 5.98); low‐certainty evidence.1,2

*The basis for the assumed risk is the risk in the control group. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the control group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; IOP: intraocular pressure; MD: mean difference; RR: risk ratio.

GRADE Working Group grades of evidence
High‐certainty: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate‐certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low‐certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low‐certainty: We are very uncertain about the estimate.

1Downgraded one level for risk of performance, detection bias, or both.
2Downgraded one level for imprecision.

Figures and Tables -
Summary of findings for the main comparison. Topical medication instillation techniques for glaucoma
Navigate to table in Review
Table 1. Commonly reported adverse events of medical glaucoma treatments

Drug class

Ocular adverse events

Systemic adverse events

Alpha‐agonists (e.g. apraclonidine, brimonidine)

Allergic reactions

Blurred vision

Burning/stinging/discomfort

Follicular conjunctival response

Hyperemia

Itching

Photophobia

Allergic reactions

Drowsiness

Dry mouth

Fatigue

Headache

Hypotension

Beta‐blockers (e.g. betaxolol, carteolol, levobunolol, timolol)

Allergy

Blurred vision

Burning/stinging/discomfort

Corneal erosion

Dry eyes

Hyperemia

Hypotony

Ptosis

Superficial punctate keratitis

Visual disturbances

Bradycardia

Depression

Dizziness or light‐headedness

Fatigue

Headache

Indigestion or heart pain

Insomnia

Joint pain

Nausea

Shortness of breath

Carbonic anhydrase inhibitors (e.g. acetazolamide, brinzolamide, dorzolamide)

Allergy

Blurred vision

Burning/stinging/discomfort

Dry eyes

Foreign body sensation

Hyperemia

Photophobia

Superficial punctate keratitis

Allergic reactions

Bitter or metallic taste

Dizziness

Fatigue

Gastrointestinal distress

Headache

Parasympathomimetics (e.g. carbachol, pilocarpine)

Blurred vision

Burning/stinging/discomfort

Eyelid twitching

Hyperemia

Itching

Increased tearing

Poor vision in dim light

Visual disturbances

Dizziness

Headache

Hypoglycemia

Increased saliva

Increased sweating

Nausea

Prostaglandin analogues (e.g. bimatoprost, latanoprost, travoprost)

Blurred vision

Burning/stinging/discomfort

Dry eyes

Eyelash growth

Foreign body sensation

Hyperemia

Increased tearing

Iris/skin discoloration

Itching

Photophobia

Cold symptoms

Exacerbation of asthma

Facial rash

Joint or muscle pain

Upper respiratory infection
Figures and Tables -
Table 1. Commonly reported adverse events of medical glaucoma treatments
Navigate to table in Review