PROJECT ABSTRACT Despite the availability of effective treatments, glaucoma remains the leading cause of irreversible blindness among African American adults and the second leading cause of irreversible blindness in the United States. Non-adherence to daily prescribed eye drop medications – the treatment for 89% of glaucoma patients - is a key modifiable driver of vision loss in glaucoma. In current practice, patients are diagnosed with glaucoma and simply given a prescription, with only 1 in 8 prescribing physicians teaching patients how to use eye drops. 40% of glaucoma patients do not take their daily eye drop medication according to the prescribed schedule. 20% of glaucoma patients do not succeed in getting drops into their eyes. Glaucoma primarily affects older adults who may have aging-related sensorimotor deficits that impair successful medication instillation. Our long term goal is to develop a comprehensive system to monitor medication use, quantify whether administered drops are successfully delivered, communicate usage data to the patient’s health care team, and coach each patient on how to use their eye drop medications. Our central hypothesis is that by identifying the biomechanical and sensorimotor factors associated with eye drop instillation success – whether a drop gets in the eye – we can develop more effective, personalized intervention strategies to improve medication adherence and increase instillation success. Our overall objectives are to: 1) use motion sensors that measure the biomechanical movement of instilling eye drops, together with tests of sensorimotor abilities, to identify factors that result in successful eye drop instillation success among older adults; and 2) use input from older participants to design a comprehensive, simple, and user-friendly Eye Drop Adherence Monitoring System (EAMS). The EAMS will consist of a low-power, portable, on-bottle sensor and a cellular-linked communication base station to identify remotely when an eye drop was dispensed and record the probability of successful instillation. The EAMS will also integrate a personalized text message program tailored to individual adherence levels. Following development, we will test the EAMS to assess the agreement between EAMS classification of an eye drop use event and eye drop instillation success and an eye drop use diary and video- recorded eye drop instillation. We will assess the acceptability of the system among a sample of glaucoma patients through qualitative interviews. Impact: Our interdisciplinary team will gain and share new knowledge about the biomechanics of eye drop instillation and the impact of the sensorimotor deficits of aging on eye drop medication use. This knowledge will inform the development of a scalable Eye Drop Adherence Monitoring System (EAMS) that can be used clinically to improve the effectiveness of glaucoma care in preventing vision loss. This tool will be able to assess adherence to eye drop medications in both the clinical and research settings. A deeper understanding will inform patient-centered approaches to self-management support and aid in closing outcomes disparities in glaucoma – and every other condition needing eye drop medications.

PROJECT NARRATIVE To preserve their vision, glaucoma patients must take daily eye drop medications; and yet, 40% of patients do not do this, and 20% are unable to successfully instill the drops into their eyes. We will quantify and understand the movement factors influencing eye drop instillation success and use this information to inform the development of a scalable Eye Drop Adherence Monitoring System that measures each time eye drops are dispensed and whether the drops are successfully instilled into the eye. Accurate monitoring of eye drop adherence is an essential step towards providing effective support for people to self-manage their glaucoma.