Can ophthalmologists correctly identify patients defaulting from pilocarpine therapy?

We determined whether clinical measurements and assessments available to ophthalmologists could be used to identify patients who default from pilocarpine treatment. The measurements and assessments included intraocular pressure, pupillary diameter, pupillary reactivity to light, the patient's report of compliance, the physician's prediction of compliance, the patient's log of pilocarpine administration, and the weight of pilocarpine eyedrops utilized. Compliance with the pilocarpine regimen was measured with an unobtrusive eyedrop medication monitor. Intraocular pressure and pupillary diameter did not correlate with compliance to the regimen as measured by the eyedrop monitor. Pupillary reaction to light, the physician's prediction of compliance, a daily log of pilocarpine administration, the weight of pilocarpine utilized, and the patient's report of compliance correlated modestly with compliance as measured by the monitor (range of correlations, 0.19 to 0.24). However, none of these measures taken by itself or combined in any manner adequately distinguished patients with lower rates of compliance from those with higher rates of compliance. At present, the eyedrop monitor is the only reliable method for detecting patients who default from treatment.