Cataract surgery is one of the most commonly performed elective surgeries in the world, with an estimated 20 million performed each year (Rossi et al, 2021). However, the average non-compliance rate for eye drop treatment post-surgery is around 30% (Vandenbroeck et al, 2011). 

The correct use of eye drops after cataract surgery is “essential for managing inflammation, preventing infection, and promoting healing”, says Preeti Singla MCOptom, an independent prescriber optometrist, and a member of Acuity’s editorial board.

“But non-compliance can lead to several postoperative complications such as endophthalmitis, persistent or rebound inflammation and raised pressure from inappropriate tapering of steroids.”

After cataract surgery, patients are typically prescribed multiple eye drops, including antibiotics to prevent infection, anti-inflammatory drops – usually corticosteroids – to reduce inflammation, and non-steroidal anti-inflammatory drug (NSAID) eye drops for additional anti-inflammatory support, says Miss Masara Laginaf, Consultant Ophthalmic Surgeon at OCL Vision, a consultant-founded and led specialist ophthalmic clinic.   

These drops must often be administered multiple times daily – often three to four times a day – for at least several weeks, she says. However, patients can struggle with the complexity of the drop regimen, she says. 

Non-compliance can occur because of forgetfulness or poor understanding, which may be more common in cases of cognitive impairment in the older adult population.   

There may be difficulty with drop instillation due to physical limitations such as arthritis or grip weakness. Instillation technique may be poor, resulting in improper use or excessive wastage, which can affect drug supply and therefore compliance, says Masara.

Another issue with compliance is that “the longer patients are on corticosteroids, the higher the risk of raised IOP [intraocular pressure] and potential optic nerve damage”, says Dr Alexander Silvester, Chief Medical Officer of SpaMedica.

“The longer patients are on drops, particularly if they can’t feel the benefits of using the drops, the more likely it is that they will stop using them, especially if drop preservatives are associated with dry eye symptoms.”