The AOA's Evidence-based Process

The AOA Evidence-based Optometry Committee has created a 14-Step process that aligns with the Institute of Medicine's recommendations for developing trustworthy clinical practice guidelines. Click on the links within this document to learn more about the process detail.

AOA's 14 Steps to Evidence-Based Clinical Practice Guideline Development

1. Guideline Development Group: Select a multidisciplinary panel of experts, including patient and public representatives, for Guideline Development Group (GDG).
2. Transparency and COI: Manage conflict of interest (COI).
3. Clinical Questions**: Explore and define all clinical questions through a Question Formulation Meeting and define search criteria (GDG).
4. Search for Evidence: Send clinical questions for query (outside researchers) and provide all papers to the Guideline Development Reading Group (GDRG). There should be no inclusion of Systematic Review (SR) writers on the Guideline Development Group (No intersection of GDG with SR writers - Not applicable to AOA at this time).
5. Grade Evidence and Clinical Recommendations: Read and grade papers (2 GDRG readers per paper, randomly selected) according to pre-designed evidence quality values. Make clinical recommendation(s) from each paper and grade the strength of each (GDRG).
6. Articulate Clinical Recommendations**: Review all clinical recommendations and articulate each for inclusion in the guideline during an "Articulation of Recommendations" meeting and document identified gaps in medical research (GDRG).
7. Write Draft: Send to writer for development of draft 1.
8. Draft Review and Edits**: Read draft 1, discuss and edit (GDG).
9. Rewrite/Final Drafts: Send to writer for writing/revisions for draft 2, then final reading / changes/rewrites as necessary.
10. Approval for Peer Review: Send to the AOA Board of Trustees for approval to post for peer and public review. Post on the AOA website, announce the review period, and solicit comments.
11. Final Document Produced: Review and revise final document (include peer review comments or identify issues for review when preparing next edition).
12. Final Approval and Legal Review: Send to the AOA Board of Trustees and AOA Legal Counsel for approval that the GDG followed the evidence-based process as outlined by the IOM and AOA EBO Committee (same management of COI).
13. Post Guideline: Post to the AOA website. Submit to the National Guideline Clearinghouse and website for public use, accompanied by our written process and documents. 
14. Schedule Reviews: Review all previously identified gaps in medical research and any new evidence, and revise guideline every 3- 5 years.

** Denotes face-to-face meeting