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Todd Hayashida Driver, Paul P Lee, Yvonne Ou; Assessing the development of guidelines for primary open angle glaucoma using the AGREE II instrument. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5588.
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As guidelines become increasingly incorporated into clinical practice through “best practice” efforts and the adoption of electronic health records, understanding the methods used for their development may be helpful in assessing their utility. We previously evaluated primary open-angle glaucoma (POAG) guidelines with the AGREE instrument and found that there was opportunity to improve guideline development. We re-evaluated available national and supranational POAG guidelines to reflect changes in both the guideline evaluation instrument and the guidelines themselves.
Four glaucoma fellowship-trained independent reviewers evaluated the current POAG guidelines published by the American Academy of Ophthalmology (AAO), South East Asia Glaucoma Interest Group (SEAGIG), European Glaucoma Society (EGS), and the UK National Institute for Health and Clinical Excellence (NICE) using the criteria prescribed by the Appraisal of Guidelines for Research and Evaluation II instrument (AGREE II). Both printed and online sources were included in the reviews.
Appraisal using the AGREE II instrument demonstrated that the AAO guideline scored favorably (>70%) in the domains of scope and purpose, rigor of development, clarity of presentation, applicability, and editorial independence, while no domain scored unfavorably (<50%). The SEAGIG guideline scored favorably in the scope and purpose domain, while scoring unfavorably in the domains of stakeholder involvement, rigor of development, applicability, and editorial independence. The EGS guideline scored favorably in the domains of clarity of presentation and applicability, while scoring unfavorably in the domains of scope and purpose, stakeholder involvement, and rigor of development. The NICE guideline scored favorably in all domains.
The development of POAG guidelines has improved over time even while the requisite characteristics for desired development have been strengthened. Nevertheless, opportunities exist for guidelines to continue to better meet AGREE II recommended characteristics.
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