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Monitoring compliance to topical therapy in children and young people with uveitis
Elspeth K Y Green1, Orlaith McGrath2, Laura Steeples2,3
1Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK. Elspeth.green@nhs.net.
Insights
Pediatric uveitis patients show poor steroid eye drop compliance, with many missing over half their doses. This unreliability in adherence can lead to suboptimal disease control and vision complications.
Area of Science:
- Ophthalmology
- Pediatrics
- Pharmacology
Background:
- Pediatric uveitis is a rare but serious condition.
- Steroid eye drops are the primary treatment, but poor adherence can cause vision loss.
- Accurate compliance measurement is crucial for effective management.
Purpose of the Study:
- To prospectively measure steroid eye drop compliance in children and young people (CYP) with uveitis.
- To assess the reliability of self-reported compliance in this pediatric population.
- To identify the extent of non-adherence and its potential impact on disease control.
Main Methods:
- Recruited 50 CYP (aged 0-18) with uveitis using steroid drops.
- Collected compliance data via questionnaires from CYP and their parents/guardians (PPR).
- Subgroup analysis involved weighing steroid drop bottles before and after use to objectively measure consumption.
Main Results:
- 33.3% of CYP and 9.7% of PPR reported frequent drop errors.
- Many parents (40.6%) could not recall prescribed drop frequencies.
- Bottle weighing revealed 75% of patients had insufficient weight reduction, with 25% using less than 50% of expected drops.
Conclusions:
- Demonstrated significantly poor eye drop compliance among pediatric uveitis patients.
- Self-reported compliance data was found to be unreliable.
- A substantial proportion of patients miss critical medication doses, potentially leading to inadequate disease management and adverse outcomes.
Background/Objectives:
Uveitis in children and young people (CYP) is a rare but potentially debilitating condition. Steroid eye drops are the first step in treatment and poor compliance may result in vision-threatening complications. This study aims to measure compliance with prescribed eye drops prospectively in a child-specific manner.
Subjects/Methods:
Patients aged 0-18 years attending a tertiary paediatric uveitis clinic using steroid drops were recruited. Both the CYP, and person with parental responsibility (PPR) completed questionnaires about compliance. A subgroup had bottles of Prednisolone 1% drops dispensed and weighed at the first appointment and reweighed at follow-up. The weight reduction was compared with expected weight change over the interval.
Results:
The study was completed by 42 patients of the 50 patients recruited. Thirty-one CYP and their respective PPR completed both questionnaires, 11 completed only one questionnaire (9 CYP, 2 PPR). Drop errors for all eye drops were reported more than "once a week" by 13/39 CYP (33.3%, 95% CI: 19.1%-50.2% of respondents), and 3/31 PPR (9.7%, CI: 19.1%-50.2% of respondents). Many PPR could not recall prescribed drop frequency (n = 13/31, 40.6%, CI: 23.7%-59.4% of respondents). Twelve patients had bottles weighed and returned. Insufficient weight reduction was found in 9 (75%, CI: 42.8%-94.5%). Within the eye drop weighing subgroup three participants (25%, CI: 5.5%-57.2%) used <50% the expected weight of drops.
Conclusions:
This study demonstrated poor eye drop compliance in CYP with uveitis. Self-reported compliance was unreliable in this population. Worryingly, some patients miss more than 50% of drops and may suffer sub-optimal disease control.
