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B. C. Samuels, Y. Ou, C. Migdal, P. P. Lee; A Critical Appraisal of Glaucoma Practice Guidelines Utilizing AGREE, IOM, and COGS Criteria. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5715.
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Practice guidelines have been used to improve the process quality of health care in order to potentially enhance patient outcomes. Prior work has shown significant opportunity for improvement in conformance to practice guidelines in the care of patients with primary open-angle glaucoma (OAG). With the presence of at least 3 major guidelines for OAG care globally, we wanted to analyze and appraise the development and content of practice guidelines from the American Academy of Ophthalmology (AAO), Southeast Asia Glaucoma Interest Group (SEAGIG), and European Glaucoma Society (EGS).
Current glaucoma clinical practice guidelines published by the AAO, SEAGIG, and EGS were evaluated using the criteria contained in 3 evaluation systems for practice guidelines: 1) Appraisal of Guidelines for Research and Evaluation (AGREE); 2), Institute of Medicine (IOM); and 3) Conference on Guideline Standardization (COGS).
Critical appraisal utilizing the AGREE instrument demonstrated that the AAO guidelines scored favorably (>70%) in the domains of rigor of development, clarity and presentation, and editorial independence, while scoring unfavorably (<50%) in the domains of stakeholder involvement and applicability. The AAO guidelines met 63% of IOM criteria and 78% of COGS criteria. The Asia Pacific Glaucoma Guidelines developed by SEAGIG scored favorably in the domains of scope and purpose and clarity and presentation, but scored unfavorably in the domains of stakeholder involvement, rigor of development, applicability, and editorial independence. The SEAGIG guidelines met 38% of IOM criteria and 50% of COGS criteria. The EGS guidelines scored favorably in the domains of scope and purpose and clarity and presentation, but scored unfavorably in the domains of stakeholder involvement, rigor of development, and editorial independence. The EGS guidelines met 50% of both IOM and COGS criteria.
While the clinical practice guidelines from AAO, SEAGIG, and EGS have contributed to developing a rational basis for glaucoma management, there is variability in the development of these guidelines as evaluated by standardized assessment systems for practice guidelines. The adoption of common standards in developing clinical practice guidelines in ophthalmology should improve their consistency and quality and may provide an avenue for global reconciliation of guideline development and content.
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