Barriers to Adherence with Corticosteroid Eye Drops in Patients with Uveitis

To assess the patient barriers to adherence with corticosteroid eye drops in patients with ocular inflammatory disorders across the United States.

This was a multicenter study of adult and pediatric patients with uveitis undergoing treatment with corticosteroid eye drops. Sites included the Johns Hopkins Wilmer Eye, the University of Texas at Austin, the University of Wisconsin-Madison, the University of Minnesota, the Minneapolis Veterans Administration Hospital, and the Washington University of St. Louis. Eligible patients completed a self-reporting survey to assess barriers to adherence with corticosteroid eye drops.

The survey was completed fully by 94 subjects and partially by 20 (115 in total), of whom were 66% White, 60% female, and 47% had a college or advanced degree. While some patients (5.5%, n = 6) self-reported never taking their corticosteroid eye drops as prescribed, most reported taking the drops as directed (54.1%, n = 59) or at least 90% of the time (29.4%, n = 32). Reasons for nonadherence were explored: 56% of patients used a corticosteroid eye drop more than once a day, and 13% found frequency a limitation to adherence. Many patients had polypharmacy, 43% took 4 or more medications, and 50% took 1 or more drops in addition to a corticosteroid eye drop. Patients also reported difficulty reading the writing on drop bottles (39%) and poor vision limiting application into the eye (17%). Almost a quarter (24%) of patients occasionally ran out of their drop before the next refill. Most patients did not report cost (98%) or insurance loss (97%) as a barrier to obtaining a refill.

Barriers to corticosteroid eye drop treatments for ocular inflammatory disease include difficulty with medication frequency, polypharmacy, medication administration, missing refills, and running out of medication early. Addressing these barriers may improve adherence with corticosteroid eye drops to achieve treatment goals.