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Connie Wu, Annie Wu, Benjamin Young, Dominic Wu, Paul B Greenberg; Cataract Surgery Quality of Care: An Evaluation of International Cataract Surgery Clinical Practice Guidelines. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2811.
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This study aims to evaluate and compare the quality of the clinical practice guidelines published by the American Academy of Ophthalmology (AAO) and the Royal College of Ophthalmologists (RCO) for the management of cataracts in adult patients.
Four evaluators independently appraised both clinical practice guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, which covers six domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence) and includes an Overall Assessment summarizing guideline quality across all domains, using a seven-point scale with a score of seven indicating 100% adherence.
Scores for the six AGREE II domains ranged from 32% to 56% with an overall rating of three out of seven for the AAO practice guideline, and ranged from 23% to 85% with an overall rating of five out of seven for the RCO practice guideline. The AAO guideline scored lower than the RCO guideline in five domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability) and higher in one domain (Editorial Independence). The inter-rater reliability for the AAO and RCO guidelines were 0.78 and 0.80 respectively, as determined by an average measures intraclass correlation coefficient.
Relative to the RCO guideline, the AAO guideline had lower adherence to the AGREE II domains. The AAO guideline can be improved by clarifying its scope and purpose, involving stakeholders in its development, and consistently applying a rating system for evidence supporting key recommendations. Both the AAO and RCO guidelines can be improved by addressing potential conflicts of interest among members of the guideline development groups.
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