Background: Uveitis is the fifth most common cause of preventable blindness in the United States and the mean per-patient total all-cause healthcare cost for noninfectious inflammatory eye disease was estimated to be $15,651 between 2006 and 2015. Without treatment, uveitis can lead to blindness through different causes, including macular edema and glaucoma. Topical corticosteroid eye drops are typically the first-line treatment, yet minimal research exists surrounding adherence to corticosteroid therapy among patients with uveitis. This study aimed to assess the effect of patient barriers, including medication cost, polypharmacy, unclear prescriber instructions, and side effects, on adherence with corticosteroid eye drops in patients with ocular inflammatory disorders throughout the United States.

Methods: This was a multicenter study of adult and pediatric patients with ocular inflammatory diseases undergoing treatment with corticosteroid eye drops. Sites included Johns Hopkins, University of Texas at Austin, University of Wisconsin, University of Minnesota, Minneapolis Veterans Administration Hospital, and Washington University of St. Louis. Eligible patients completed a survey consisting of 45 questions to assess barriers to adherence with corticosteroid drops. Reasons for medication non-adherence and the importance of patient demographics, including age, race, sex, region, insurance type, education level, and drop frequency were assessed for the impact on corticosteroid eye drop adherence.

Results: The survey was completed fully by 94 subjects and partially by 20 (114 in total), of whom were 66% white, 60% female, and 47% had a college or advanced degree. Fifty-six percent of patients used a corticosteroid drop more than once a day; 13% found frequency a limitation to adherence. Many patients also had polypharmacy–43% took 4 or more medications and 50% took 1 or more drops in addition to a corticosteroid 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 prior to the next refill. Most patients did not report cost (98%) or insurance loss (97%) as a barrier to obtaining a refill.

Conclusion: Socioeconomic barriers to topical corticosteroid treatment for uveitis include difficulty with medication frequency, polypharmacy, medication administration, missing refills, and running out of medication early. No patients missed doses due to insurance loss and the majority did not report cost as a barrier to obtaining refills. Addressing these barriers to treatment with patients can promote adherence with corticosteroid drops to achieve treatment goals.