Evidence-based clinical practice guidelines ensure optometry has the latest care recommendations available to provide maximal, timely patient care—no matter where doctors are in their career.
Industrywide, clinical practice guidelines made a transformative shift from consensus-based to evidence-based guidance in 2011 with landmark reports from the National Academies of Sciences, Engineering and Medicine (NASEM). This change emphasized not only transparency but also a thorough peer-review process that weights the best available clinical evidence.
In fact, the National Guideline Clearinghouse (NGC), maintained by the Agency for Healthcare Research and Quality, required all guidelines to meet eight meticulous standards before they're accepted into the repository. Those include:
- Establish transparency.
- Manage conflict of interest.
- Establish a varied, multidiscipline guideline development group.
- No intersection of guideline development group members and systematic review writers.
- Establish a process for grading quality of evidence and rating the strength of clinical recommendations.
- Articulate clinical recommendations.
- Conduct an external, peer and public review process.
- Establish a 3-5-year update or review process.
The AOA was quick to follow suit and began its first-ever evidence-based clinical practice guideline, Eye Care of the Patient with Diabetes Mellitus, in May 2011. That guideline went on to be accepted by the NGC in 2014, as did the subsequent Comprehensive Adult Eye and Vision Examination and Comprehensive Pediatric Eye and Vision Examination in 2016 and 2017, respectively. Moreover, AOA's guidelines have twice been honored by the American Public Health Association.
Such external validation is proof that AOA's systematic, rigorous guideline development process produces clinical recommendations that practitioners can trust and employ in their practices daily. Here are four ways the AOA's evidence-based guidelines support the profession at every level.
- Students. The AOA's Evidence-based Optometry Committee devotes nearly 3,000 hours on each guideline, following a strict, 14-step development process to review and grade thousands of abstracts, papers and studies. The end-result is a thorough, peer-reviewed guideline that AOA presents to the Association of Schools and Colleges of Optometry to incorporate into education at schools and colleges of optometry nationwide. Students and new doctors should review the guideline for the latest recommendations in patient care.
- Primary eye care providers. Those recommendations are further stratified by subject and strength of evidence. Doctors of optometry can consult the Action Statement Profiles (green boxes) with additional information related to the development and implementation of the clinical recommendation. These Action Statement Profiles include grading for the quality of evidence used—A, B, C and D—and the strength of clinical recommendation. The latter include:
- Strong recommendation - This recommendation should be followed unless clear and compelling rationale for an alternative approach is present. The quality of evidence provides a clear reason to make a recommendation.
- Recommendation - This recommendation should generally be followed but remain alert for new information. The quality of evidence is not as strong, but the benefits exceed the harms or vice versa.
- Discretional - There should be awareness of this recommendation, but a flexibility in clinical decision-making, as well as remaining alert for new information. No clear advantage has been demonstrated for one approach versus another. There is a lack of pertinent evidence and an unclear balance between benefit and harm.
- Educators, researchers or the curious. Action Statement Profiles also provide useful information for researchers and educators, or those simply wanting more detail about recommendations, at the very bottom of the "green boxes." Look for the "Gaps in Evidence" section to learn if the development committee identified a paucity of evidence related to a specific recommendation or guidance. Also consider reviewing references for more detail on how the committee came to those conclusions.
- Profession. Ultimately, these recommendations were developed to assist doctors of optometry and ophthalmologists involved in providing eye and vision care, but others assisting in coordinated patient care, as well as patients themselves, may benefit from these guidelines. In this way, AOA's evidence-based guidelines are looked at with authority, helping elevate the profession and setting up better research moving forward. Moreover, these documents are available to public and patient stakeholders, as well as other entities to better demonstrate optometry's level of care.
Read more about AOA's evidence-based clinical practice guidelines in the November/December 2017 edition of AOA Focus.