Glaucoma eye drops require perfect daily compliance but 50% of patients stop within 6 months

Glaucoma is the leading cause of irreversible blindness worldwide, and the primary treatment — daily prostaglandin eye drops — requires perfect lifelong compliance because missed doses cause silent, irreversible optic nerve damage that the patient cannot feel until peripheral vision is permanently gone. Studies show that 50% of glaucoma patients discontinue drops within six months and only 10% maintain perfect adherence at two years. The drops sting, cause cosmetic side effects (darkened iris, eyelash growth), and require precise technique that elderly patients with arthritis physically cannot perform — yet ophthalmologists prescribe the same bottle-and-squeeze delivery system that has not changed since 1996. Sustained-release implants (Durysta, iDose) exist but cost $10,000-15,000 per eye and are only approved for specific glaucoma subtypes, while pharmacy-dispensed unit-dose preservative-free options (which eliminate the squeeze-bottle problem) are reimbursed at the same rate as traditional bottles, giving manufacturers no incentive to switch.