Patient Demographics (1)What is your year of birth?                 _____________

(2)How many years ago were you diagnosed with Sjögren’s syndrome? Please answer in years.                 _____________

(3) Who diagnosed you with Sjögren’s syndrome? Rheumatologist (1) Ophthalmologist (2) Family Doctor (3) Other Doctor (4) Self-diagnosed (5)

(4) What testing was used to make your diagnosis? Salivary gland biopsy (1) Blood work (2) Salivary flow testing (3) None of the above (4)

Employed Therapies, Cost, and Insurance (5) Have you been advised to use preservative-free artificial tears? Yes (1) No (2) Prefer not to disclose (3)

(6) How much are you spending on preservative-free artificial tears every month? Less than $25 (1) $25–$50 (2) $50–$100 (3) $100–$200 (4) More than $200 (5)

(7) Are you currently being prescribed Restasis? Yes (1) No (2) Prefer not to disclose (3)

(8) How much are you spending on your Restasis every month? Less than $100 (1) $100–$200 (2) $200–$300 (3) $300–$400 (4) $400–$500 (5) More than $500 (6)

(9) Do you have private medical insurance through your employer? Yes (1) No (2) Prefer not to disclose (3)

(10) Does your private medical insurance cover your non-prescription artificial tears and ointments? Yes (1) No (2) Prefer not to disclose (3)

(11) Does your private medical insurance cover all of your prescription eye medications? Yes (1) No (2) Prefer not to disclose (3)

(12)If there is a limit to your insurance coverage, how much is your limit?                 __________

(13)If your insurance has a limit, what are your out-of-pocket expenses for your dry eye prescription and non-prescription tears, gels, and ointments every month?

__________

(14)If you do not have insurance, what are your out-of-pocket expenses for your dry eye prescription and non-prescription tears, gels, and ointments every month?                 __________

Non-Adherence and Rationing Strategies (15) What are the reasons that you may not be using your dry eye medications and artificial tears as advised by your doctor? Cost (1) Inconvenience (2) Side effects (3) Forgetting (4) Other medical conditions (5) Difficulty filling prescriptions (6) Difficulty putting in drops due to vision (7) Difficulty putting in drops due to arthritis (8) Difficulty putting in drops due to lack of assistance (9) Other—Please describe (10)

(16) In order to make your drops last longer, have you ever tried any of the listed techniques (select all that apply)? Using drops past expiry (1) Using fewer drops than prescribed (2) Using the same single-use medications for more than one day (3) Using preserved drops instead of non-preserved (4) Diluting eye medications (adding other liquids to decrease cost) (5) Ignoring symptoms to avoid cost (6) Spending less on basic needs to buy medicine (7) Asking for free samples from physicians (8) Other—Please describe (9)

(17)How many times per day have you been advised to use your artificial tears?                 ___________

(18)How many times per day do you use your artificial tears on average?                 ___________

(19) It is often difficult to follow through with medication regimens. How many drops do you miss per day? Less than a third (1/3) of drops missed (1) Between a third (1/3) and half (1/2) of drops missed (2) Between half (1/2) and two thirds (2/3) of drops missed (3) More than two thirds (2/3) of drops missed (4)

(20) How do your eyes feel when you miss your artificial tear drops? Irritated (1) Itchy (2) Dry (3) Like there is something stuck in the eye (4) Burning (5) Painful (6) None (7)

(21) If you have experienced side effects from your prescription eye medications, please select them below. Tearing (1) Postnasal drip (2) Visual disturbances (3) Eye irritation (4) Itching (5) None (6)

Nondisclosure and Patients Fears (22) Sometimes it may be difficult to follow medical advice. Do you tell your eye doctor when you are not using your prescription medications or artificial tears as directed? Yes (1) No (2) Prefer not to disclose (3)

(23) Why do you not tell your doctor about these difficulties? Financial difficulties (1) Physical difficulties (2) Difficulty accessing pharmacy (3) Other (4)

(24) Does your dry eye disease affect your life in any of the following ways? Reduced quality or amount of sleep (1) Reduced ability to concentrate (2) Difficulty with vision (3) L Limitation in your ability to enjoy your daily activities (4) Difficulty driving (5) Difficulty enjoying outdoor activities (6) Difficulty with work-related activities (7)

(25) What do you worry most about your dry eye disease? Reduction in quality of life (1) Long-term visual changes (2) Pain (3) Other (4)

(26) Information about income is very important to understand. Please select the answer that includes your entire household income in 2017 before taxes in Canadian dollars. Less than $10,000 (1) $10,000 to $19,999 (2) $20,000 to $29,999 (3) $30,000 to $39,999 (4) $40,000 to $49,999 (5) $50,000 to $59,999 (6) $60,000 to $69,999 (7) $70,000 to $79,999 (8) $80,000 to $89,999 (9) $90,000 to $99,999 (10) $100,000 to $149,999 (11) $150,000 or more (12) Prefer not to disclose (13)