A study from Wilmer Eye Institute researchers showed that physician understanding of patient topical ophthalmic medication use based solely on bottle cap color is frequently incorrect, particularly in patients with glaucoma. Errors based on communication using bottle cap color alone may be common and could lead to confusion and harm.

Patients aged ≥18 years with primary open-angle, primary angle-closure, pseudoexfoliation or pigment-dispersion glaucoma, bilateral visual acuity of ≥20/400 and no concurrent conditions that may affect color vision were included in this cross-sectional study. One hundred patients provided color descriptions of 11 distinct medication bottle caps. Color descriptors were presented to three physicians who matched each color descriptor to the medication they thought the descriptor was describing. The main outcome measure was frequency of patient-physician agreement, i.e., all three physicians accurately matched the color descriptor to the correct medication. Multivariate regression models evaluated whether patient-physician agreement decreased with degree of better-eye visual field damage, color descriptor heterogeneity or color vision deficiency, as determined by the Hardy-Rand-Rittler (HRR) score and Lanthony D15 color confusion index (D15 CCI).

Subjects had a mean age of 69 (±11) years, with VF mean deviation of -4.7 (±6.0) and -10.9 (±8.4) decibels in the better- and worse-seeing eyes, respectively. Patients produced 102 unique color descriptors to describe the colors of the 11 bottle caps. Among individual patients, the mean number of medications demonstrating agreement was 6.1/11 (55.5 percent). Agreement was <15 percent for four medications (prednisolone acetate, betaxolol HCl, brinzolamide/brimonidine and latanoprost). Lower HRR scores and higher D15 CCI, both indicating worse color vision, were associated with greater VF damage (p<0.001). The extent of color vision deficiency and color descriptor heterogeneity significantly predicted agreement in multivariate models (odds of agreement = 0.90 per one point decrement in HRR score, p<0.001; odds of agreement = 0.30 for medications exhibiting high heterogeneity [≥11 descriptors], p=0.007).

Ophthalmology 2015;122:2373-2379.
Dave P, Villareal G, Friedman D, Kahook M, et al.

Provider Communication Improves Eye Exam Adherence
Researchers from the Wills Eye Hospital evaluated the effect of written communication between an ophthalmologist and a primary-care physician on patient adherence to diabetic eye exam recommendations, and found that those patients with communication between providers are more likely to adhere to examinations.

In the retrospective cohort study, records of all patients with diabetes (n=1,968) and clinic visits between 2007 and 2010 were reviewed to collect: patient demographics; insurance status; hemoglobin A1C; severity of diabetic retinopathy; follow-up examinations; and written communication between a patient’s ophthalmologist and primary-care physician. Statistical analyses examined the relationship between physician communication and adherence to diabetic eye exam based on the American Academy of Ophthalmology-published recommendations.

Written communication from an ophthalmologist to a primary-care physician was associated with increased adherence to follow-up eye examination recommendations (odds ratio: 1.49; 95 percent confidence interval: 1.16 to 1.92; p=0.0018). Communication from a primary-care physician to an ophthalmologist was also associated with increased adherence (OR: 1.94; 95 percent CI: 1.37 to 2.77; p=0.0002). Multivariable analysis controlling for other factors associated with examination adherence confirmed that communication both to and from an ophthalmologist was independently and significantly associated with increased follow-up adherence.

Retina 2016;36:20-27.
Storey P, Murchison A, Pizzi L, Hark L, et al.