Adherence to Treatment Regimen in Uveitis Patients in a Tertiary Hospital in Orissa

Uveitis is a leading cause of ocular morbidity, most cases being idiopathic. The advent of steroid therapy has brought about drastic reduction in the incidence of ocular complications of uveitis. However, an array of sideeffects comes along with the benefits of steroids. As noted in our study population, adverse effects of steroids range from increased intraocular pressure and cataract to systemic side-effects including peptic ulcer disease, adrenal suppression and psychosis, etc. Often a non-adherence to treatment regimen is a setback to patient management. Our cross-sectional study involved 84 patients of uveitis and data was analyzed in terms of course of disease and visual outcome. The study aims to report the result of improper counseling, noncompliance of patient to regimen, lack of follow-up and lack of referral to rheumatologist, before the sequelae of uveitis and steroid side effects set-in. The most common form of uveitis noted was acute anterior uveitis (72.61%) and most common diagnosis was Idiopathic and Ankylosing spondylosis (36.9 % and 20.23% respectively). Most common factor affecting adherence to treatment was financial limitation (69.04%), prolonged duration of treatment (61.9%) and inadequate counseling (40.47%), others being quiescent phase of disease(14.28%), and miscellaneous other causes. Patients (32.14%) without complication at presentation and 11.9 % with complications at presentation, who remained in follow up with ophthalmologist and rheumatologist attained better visual outcome (6/366/6) and less uveitic sequelae or steroidal side-effects. Strict vigilance of patient dosing and titration as per clinical response, frequent follow-up, proper counseling, multidisciplinary management and shift to immunosuppressives resulted in good visual outcome and improved quality of life. Financial setback and inadequate understanding of the acuteness of disease and treatment were seen to have a major role in adherence to regimen in our region. Proper multidisciplinary approach would reduce the protracted course of disease and cost of treatment.