Use AOA’s new evidence-based guideline to improve exams every day

Doctors of optometry perform standard exams and tests in their practices on a daily basis. But what does the latest peer-reviewed research say about best practices—and how can doctors use that research to improve their daily work?

"The goal of these guidelines is to enable optometrists to provide the best patient care they can."

The AOA's newly revised Comprehensive Adult Eye and Vision Examination guideline helps answer these questions. The guideline, now available to AOA members, includes 16 action statements that describe appropriate examination procedures for evaluation of the eye health and vision status of adult patients to ensure clear, comfortable vision.

"The ultimate goal of these guidelines is to enable optometrists to provide the optimal and best patient care they can," says Diane Adamczyk, O.D., who chairs the AOA Evidence-Based Optometry (EBO) Committee that developed the guideline. "These guidelines provide the practitioner with an evidence-based approach to providing care to the patient, as well as noting the areas where there are gaps in the evidence and further research is needed."

A comprehensive tool for comprehensive exams
Regular comprehensive exams are critical for early diagnosis and treatment, particularly because many eye disorders have no obvious symptoms. The guideline offers a research-based tool for optometrists to make comprehensive exams as effective as possible.

The guideline covers exam procedures, appropriate tests, eye diseases and disorders, and exam frequency. A patient counseling section addresses issues such as smoking, eye protection and UV exposure.

The guideline meets revised standards from the Institute of Medicine in 2011 that called for new clinical guidelines to adhere to a stringent  evidence-based approach to development. It was developed by a cross-disciplinary team of optometric experts and specialists who studied hundreds of scientific papers and studies. The team narrowed down approximately 1,700 abstracts to 74 scientific papers, which were then read and graded on the evidence, Dr. Adamczyk says. In addition, the guideline was available for public review and feedback.

"The process is very detailed," she says. "The goal is to base these guidelines on the best evidence and science out there."

Some of the recommendations are based on consensus statements because of a lack of evidence. In addition, the committee points out gaps in research in the areas of exam frequency, new IOP tests used to diagnose glaucoma, the validity of confrontation visual field testing, and the relationship between vision loss and falls.

The vigorous guideline development process "is an example of how we are elevating our profession and is critically important in our health care environment," Dr. Adamczyk says.