Development of a 3D-printed Medication Label for the Blind and Visually Impaired
This study explored the potential of three-dimensional printing (3DP) technology in producing a three-dimensional (3D) medication label for blind and visually impaired (BVI) patients to ease their drug administration. Different variations of label wordings, dosing instructions, and medication identifiers were designed with reference to guidelines by the American Foundation for the Blind. Shapes and symbols were used as dosing instructions and medication identifiers to the patient’s medical conditions. Prototype designs were created with common graphics computer-assisted drafting software and 3Dprinted using acrylonitrile butadiene styrene as the polymer filament. Feedback was then obtained from five people with normal vision and four BVI persons. The initial prototype comprised four components, namely, medication name and strength, patient’s name, dosing instruction, and medication identifier. A revised label comprising the latter two components was developed after feedback by BVI persons. Words were in all uppercase and regular font type, with a 5-mm center-to-center letter spacing. Elevation heights of the letters alternated between 1 mm and 1.5 mm. A half sphere represented the medication dose unit, while vertical lines and a horizontal center line with alternating elevation of arrowheads represented the frequency of administration and the medication’s consumption in relation to food, respectively. Symbols based on target organs were used as medication identifiers. With rapid advancements in 3DP technologies, there is tremendous potential for producing 3D labels in patients’ medication management.
1. World Health Organization, 2019, Blindness and Vision Impairment. Available from: https://www.who.int/newsroom/fact-sheets/detail/blindness-and-visual-impairment. [Last accessed on 2020 Apr 28].
2. American Foundation for the Blind, 2020, Facts and Figures on Adults with Vision Loss. American Foundation for the Blind, Arlington County. Available from: http://www.afb.org/info/blindness-statistics/adults/facts-and-figures/235. [Last accessed on 2020 Apr 19].
3. Zuckerman DM, 2020, Blind Adults in America: Their Lives and Challenges. Available from: http://center4research.org/wp-content/uploads/2010/05/blind02041.pdf. [Last accessed on 2020 Apr 19].
4. Orrico KB, 2013, Caring for Visually Impaired Patients. J Am Pharm Assoc, 53: e142–50.
5. Cire B, 2016, World’s Older Population Grows Dramatically. Available from: https://www.nih.gov/news-events/newsreleases/worlds-older-population-grows-dramatically. [Last accessed on 2020 Apr 19].
6. World Health Organization, 2020, Change the Definition of Blindness. World Health Organization, Geneva. Available from: https://www.who.int/blindness/Change the Definition of Blindness.pdf. [Last accessed on 2020 Apr 19].
7. Sansgiry SS, Pawaskar MD, Bhounsule P, 2012, Over-the counter Medication Purchase and Use by Blind Consumers. J Health Care Poor Underserved, 23:1048–57. DOI: 10.1353/hpu.2012.0095.
8. Wong TY, Chong EW, Wong WL, et al., 2008, Prevalence and Causes of Low Vision and Blindness in an Urban Malay Population: The Singapore Malay Eye Study. Arch Ophthalmol, 126:1091–9. DOI: 10.1001/archopht.126.8.1091.
9. Zheng Y, Lavanya R, Wu R, et al., 2011, Prevalence and Causes of Visual Impairment and Blindness in an Urban Indian Population: The Singapore Indian Eye Study. Ophthalmology, 118:1798–804. DOI: 10.1016/j.ophtha.2011.02.014.
10. American Foundation for the Blind, 2020, Guidelines for Prescription Labelling and Consumer Medication Information for People with Vision Loss. American Foundation for the Blind, Arlington County. Available from: https://www.afb.org/blindness-and-low-vision/your-rights/rx-label-enablecampaign/guidelines-prescription-labeling. [Last accessed on 2020 Apr 19].
11. Little J, 2006, Effective and Confidential Communication of Prescription Information: Accommodating the Blind and Visually-impaired. In: Mann WC, Helal AA, editors. Promoting Independence for Older Persons with Disabilities: Selected Papers from the 2006 International Conference on Aging. Disability and Independence. IOS Press,US.
12. McMahon JM, Curtis A, 2009, Methods of Reading Information on Labels of Prescription Medications by Persons Who Are Visually Impaired. J Vis Impair Blind, 103(5):303–8. DOI: 10.1177/0145482x0910300508.
13. Massof RW, 2009, The Role of Braille in the Literacy of Blind and Visually Impaired Children. Arch Ophthalmol, 127(11):1530–1. DOI: 10.1001/archophthalmol.2009.295.
14. Kaur S, 2012, How is Internet of the 3D Printed Products Going to Affect Our Lives? Pushing Frontiers with the First Lady of Emerging Technologies. IETE Tech Rev, 29(5):360–4. DOI: 10.4103/0256-4602.103164.
15. Rengier F, Mehndiratta A, von Tengg-Kobligk H, et al., 2010, 3D Printing Based on Imaging Data: Review of Medical Applications. Int J Comput Assist Radiol Surg, 5(4):335–41. DOI: 10.1007/s11548-010-0476-x.
16. Gu BK. Kwon K, Park S.J., et al., 2018, 3D Bioprinting Technologies for Tissue Engineering Applications, Advances in Experimental Medicine and Biology. In: Chun HP, Kwon I, Khang G, editors. Cutting-Edge Enabling Technologies for Regenerative Medicine. Vol. 1078. Springer, Berlin. DOI: 10.1007/978-981-13-0950-2.
17. Mehrban N, Teoh GZ, Birchall MA, 2016, 3D Bioprinting for Tissue Engineering: Stem Cells in Hydrogels. Int J Bioprint, 2(1):20. DOI: 10.18063/ijb.2016.01.006.
18. Hou X, Liu S, Wang M, et al., 2016, Layer-by-Layer 3D Constructs of Fibroblasts in Hydrogel for Examining Transdermal Penetration Capability of Nanoparticles. SLAS Technol, 22(4):447–53. DOI: 10.1177/2211068216655753.
19. Hong N, Yang GH, Lee J, et al., 2018, 3D Bioprinting and it’s In Vivo Applications. J Biomed Mater Res B Appl Biomater, 106(1):444–59.
20. Xu T, Gregory CA, Molnar P, et al., 2006, Viability and Electrophysiology of Neural Cell Structures Generated by the Inkjet Printing Method. Biomaterials, 27(19):3580–8. DOI: 10.1016/j.biomaterials.2006.01.048.
21. Rimington RP, Capel AJ, Christie SD, et al., 2017, Biocompatible 3D Printed Polymers Via Fused Deposition Modelling Direct C2C12 Cellular Phenotype In Vitro. Lab Chip, 17(17):2982–93. DOI: 10.1039/c7lc00577f.
22. Culmone C, Gand S, Breedveld P, 2019, Additive Manufacturing of Medical Instruments: A State-of-the-Art Review. Addit Manuf, 27:461–73. DOI: 10.1016/j.addma.2019.03.015.
23. Swee LS, Wai YY, Florencia EW, et al., 2017, Direct Selective Laser Sintering and Melting of Ceramics: A Review. Rapid Prototyp J, 23(3):611–23.
24. Galante R, Figueiredo-Pina C, Serro AP, 2019, Additive Manufacturing of Ceramics for Dental Applications: A Review. Dent Mater, 35(6):825–46. DOI: 10.1016/j.dental.2019.02.026.
25. Yu WH, Sing SL, Chua CK, et al., 2019, Particle-Reinforced Metal Matrix Nanocomposites Fabricated by Selective Laser Melting: A State of the Art Review. Prog Mater Sci, 104:330–79. DOI: 10.1016/j.pmatsci.2019.04.006.
26. Goh GD, Yap YL, Tan HK, et al., 2020, Process-Structure Properties in Polymer Additive Manufacturing via Material Extrusion: A Review. Crit Rev Solid State Mate Sci, 45(2):113–33. DOI: 10.1080/10408436.2018.1549977.
27. Ou YH, Ou YH, Gu J, et al., 2019, Personalised Anaesthetic Patches for Dental Applications. Int J Bioprint, 5:15. DOI: 10.18063/ijb.v5i2.203.
28. Lim SH, Chia SM, Kang L, et al., 2016, Three Dimensional Printing of Carbamazepine Sustained-Release Scaffold. J Pharm Sci, 105(7):2155–63. DOI: 10.1016/j.xphs.2016.04.031.
29. Domingo-Espin M, Travieso-Rodriguez JA, Jerez-Mesa R, et al., 2018, Fatigue Performance of ABS Specimens Obtained by Fused Filament Fabrication. Materials, 11(12):2521. DOI:10.3390/ma11122521.
30. Berla EP, 1982, Haptic Perception of Tangible Graphic Displays. In: Wand S, Foulke E, editors. Tactual Perception: A Sourcebook. Cambridge University Press, Cambridge. pp. 364–86.
31. Ministry of Health Singapore, 2020, Chronic Disease Management Programme (CDMP). Ministry of Health Singapore, Singapore. Available from: https://www.moh.gov. sg/policies-and-legislation/chronic-disease-managementprogramme-(cdmp). [Last accessed on 2020 Apr 19].
32. ASTM, 2015, ISO/ASTM52900-15 Standard Terminology for Additive Manufacturing-General Principles-Terminology. Available from: https://www.astm.org/standards/isoastm52900.htm. [Last accessed on 2020 Apr 19].
33. XYZPrinting, 2020, da Vinci 1.0. Available from: https://www.xyzprinting.com/en-us/product/da-vinci-1-0. [Last accessed on 2020 Apr 19].
34. Giannatsis Jand Dedoussis V, 2009, Additive Fabrication Technologies Applied to Medicine and Health Care: A Review. Int J Adv Manuf Technol, 40(1-2):116–27. DOI:10.1007/s00170-007-1308-1.
35. Ngee Ann Polytechnic, 2020, Dialogue in the Dark. Available from: http://www.dialogueinthedark.com.sg. [Last accessed on 2020 Apr 19].
36. The United States Pharmacopeial Convention, 2012, Prescription Container Labeling. Pharmacopeia and National Formulary, United States. Available from: https://www.usp. org/sites/default/files/usp/webform/c17.pdf. [Last accessed on 2020 Apr 19]. DOI: 10.4135/9781412963855.n1200.
37. Campbell T, Williams C, Ivanova O, et al., Could 3D Printing Change the World? Technologies, Potential, and Implications of Additive Manufacturing. Available from: http://www. globaltrends.thedialogue.org/wp-content/uploads/2014/11/could-3d-printing-change-the-world-technologies-potentialand-implications-of-additive-manufacturing.pdf. [Last accessed on 2020 Apr 19]. DOI: 10.1089/3dp.2014.1501.
38. Englehardt JB, Allnatt R, Mariano A, et al., 2001, An Evaluation of the Functionality and Acceptability of the Voice Prescription Label. DOI: 10.1177/0145482X0109501108.
39. McDonald S, Dutterer J, Abdolrahmani A, et al., 2014, Tactile Aids for Visually Impaired Graphical Design Education. In: The 16th International ACM SIGACCESS Conference on Computers and Accessibility. ACM, Rochester, New York, USA. pp. 275–6. DOI: 10.1145/2661334.2661392.
40. Ramsamy-Iranah S, Maguire M, Gardner J, et al., 2016, A Comparison of Three Materials Used for Tactile Symbols to Communicate Colour to Children and Young People with Visual Impairments. Br J Vis Impair, 34(1):54–71. DOI:10.1177/0264619615610161.