Abstract
In the face of enormous evidence supporting the significance of using prescribed eye drops before and after cataract surgery, noncompliance is still a common issue. Improvements in cataract surgical procedures with no dedication to support patients throughout their pre-operative management and post-operative recovery deliver low-quality healthcare and may lead to substantial harm to the patient and the public. Therefore, it is vital for clinicians to carefully address the factors of noncompliance with prescribed eye drops and then educate their patients regarding this. This article provides full details of the factors affecting noncompliance with prescribed eye drops in patients undergoing cataract surgery.
Keywords: Cataract, cataract surgery, eye drops, noncompliance, patient education
Cataract is the leading source of blindness.1–3 Cataracts can be divided into several categories, such as congenital cataracts, age-related cataracts, cataract in systemic disease (e.g. diabetes mellitus, hypertension, myotonic dystrophy, atopic dermatitis, and neurofibromatosis type 2), secondary (complicated) cataract developing as a result of other primary ocular diseases (e.g. chronic anterior uveitis, acute congestive angle closure, high myopia, and hereditary fundus dystrophies), secondary to medication (e.g. systemic corticosteroids), traumatic cataract, and radiation cataract.1 –3 Contributing risk factors for the development of cataracts include older age, smoking, alcohol use, sunlight exposure, ocular trauma, radiation, nutritional deficiency, family history, obesity, systemic diseases, acute dehydrating diseases, use of systemic corticosteroids, congenital disorders, previous eye surgery, and other primary ocular diseases.1,2
Cataract surgery is one of the most common surgeries in the world.2 The immediate pre-operative and post-operative time before and after cataract surgery are both well-accepted practice period for the prescription of antibiotic eye drops for the prevention of infection and steroid or non-steroidal anti-inflammatory drug (NSAID) eye drops for the prevention of inflammation and pain relief.1–3 These eye drops may be dispensed with different frequencies.1–3 The justification for the administration of eye drops is a well-known, competent, convenient, noninvasive scheme of delivering drugs to the anterior segment of the eye.1–3
However, patient noncompliance with prescribed eye drops is a prevalent issue in patients undergoing cataract surgery and may cause a less than optimal end result, with potential complications, such as infection or inflammation, and corneal abrasions from a bottle tip.1 –3 The number of drops entering the eye cannot be controlled by some patients and they finish instilling too many eye drops, or a stream of eye drops, which may accordingly induce systemic side effects, especially if instillation is not accomplished by punctal occlusion.1 –3 Wastage of eye drops and additional financial costs are also enforced.1–3 The interval between eye drops may not also be traced by the patient, and the optimal absorption is consequently missed.1–3
Many studies have investigated the scale of patient noncompliance before and after the cataract surgery to spot contributing factors.4,5
The author has identified that noncompliance with prescribed eye drops in patients undergoing cataract surgery may occur due to many factors, such as complex treatment regimens, confusion with generic substitutions used, little or no experience with eye drop use, inappropriate instillation technique, poor hand–eye coordination, reduced visual acuities, aging, problems with manual dexterity, lack of tactile sensibility, tremor of the hands or head, difficulty in tilting the head back, other concomitant diseases (e.g. neurologic diseases, rheumatoid arthritis, osteoarthritis, carpal tunnel syndrome, and stroke), different types of disability, cognitive or memory problems, financial burden, requirement for an additional prescription, and lack of patient education.1–3
In summary, the author calls all eye care practitioners to be vigilant to this imperative hindrance throughout the pre-operative management and post-operative recovery of patients and to try their best to carefully address the factors of noncompliance with prescribed eye drops and then educate their patients regarding this.
Acknowledgments
Not applicable.
Footnotes
ORCID iD: Ali Nouraeinejad 
https://orcid.org/0000-0001-6964-9623
Declarations
Ethics approval and consent to participate: Not applicable.
Consent for publication: The author has full right to publish this manuscript.
Author contribution(s): Ali Nouraeinejad: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; Writing – original draft; Writing – review & editing.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Availability of data and materials: Not applicable.
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