The truth about compliance.

When confronted with an adverse response to contact lens wear, practitioners are often quick to 'blame the victim'. Although patient compliance may well be lacking, the reasons for this need to be considered carefully, along with all of the other possible contributing factors, if the safety of contact lens wear is to be improved. This Presidential Address briefly reviews what the contact lens literature has revealed about patient compliance in the context of what has been known for many years in general eye care and, indeed, general medicine. Essentially, compliance with contact lens systems is poor (40-90% of patients are noncompliant) and difficult to predict in individual patients. Neither a compliance-enhancement strategy (intense education) nor reduction of the cost of goods has any significant effect upon the level of compliance. Assessment of personality is not a reliable compliance predictor. A compliance enhancement model is proposed which encompasses the following four components: (a) the clinic and the practitioner, (b) the patient, (c) the advice that is given, and (d) the contact lens industry.