Monitoring compliance to topical therapy in children and young people with uveitis

Abstract BackgroundUveitis in children and young people 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 aimed to measure compliance with prescribed eye drops prospectively and investigate reasons for non-compliance in a child-specific manner. Methods50 patients aged 0-18 years attending a tertiary paediatric uveitis clinic using steroid drops were recruited. Both the child or young person, and parent completed questionnaires about compliance. A subgroup had bottles of Prednisolone 1% drops weighed and dispensed at the first appointment and reweighed at follow-up. The reduction in weight was compared with expected weight change over the interval. ResultsThe study was completed by 31 patients. Drop errors for all eye drops were reported more than “once a week” by 13 (33.3%) children and young people, and 3 (9.7%) parents. A large proportion of parents could not recall the frequency of drops prescribed to their child (13, 40.6%). Insufficient bottle weight reduction was found in 9 (75%), although this was not associated with self-reported drop errors. Within the eye drop weighing subgroup three (25%) used <50% the expected weight of drops. ConclusionsEye drop compliance was demonstrated to be poor by all the study outcomes in children and young people with uveitis. Self-reported compliance is unreliable in this population, as subjective responses were not supported by objective bottle weight change. Worryingly, some patients miss more than 50% of drops and may suffer worse disease control. Clinical implicationsWhat is already known on this topicPoor drop compliance among children and young people with uveitis has been suggested by a previous retrospective study looking at self-reported compliance.What this study addsAll subjective and objective metrics in this prospective study suggest steroid eye drop compliance is often poor among children with uveitis.Parental administration of steroid eye drops and shorter disease duration appear to be associated with improved compliance.How this study might affect research, practice or policySelf-reported compliance is highly unreliable and should be treated as such by practising clinicians and any future studies.Among the patients with drop errors a small but clinically significant number have very poor compliance and miss drops daily. These patients are at high risk for sub-optimal disease control or persistent disease activity and this requires further investigation. Synopsis/PrecisThis prospective study of drop compliance in children and young people with non-infectious uveitis suggests drop compliance is poor. Some individuals use drops less than half of the prescribed frequency. Self-reported compliance was highly unreliable.