Abstract
Purpose. To evaluate the methodological quality of age-related macular degeneration (AMD) clinical practice guidelines (CPGs). Methods. AMD CPGs published by the American Academy of Ophthalmology (AAO) and Royal College of Ophthalmologists (RCO) were appraised by independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which comprises six domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence), and an Overall Assessment score summarizing methodological quality across all domains. Results. Average domain scores ranged from 35% to 83% for the AAO CPG and from 17% to 83% for the RCO CPG. Intraclass correlation coefficients for the reliability of mean scores for the AAO and RCO CPGs were 0.74 and 0.88, respectively. The strongest domains were Scope and Purpose and Clarity of Presentation. The weakest were Stakeholder Involvement (AAO) and Editorial Independence (RCO). Conclusions. Future AMD CPGs can be improved by involving all relevant stakeholders in guideline development, ensuring transparency of guideline development and review methodology, improving guideline applicability with respect to economic considerations, and addressing potential conflict of interests within the development group.
Highlights
Blindness caused by age-related macular degeneration (AMD) affects an estimated 32.4 million people worldwide, with an additional 191 million people suffering from moderate and severe AMD-related vision impairment [1]
The Academy of Ophthalmology (AAO) clinical practice guidelines (CPGs) scored lowest in Domain 2 (Stakeholder Involvement) with an average score of 35% and highest in Domain 1 (Scope and Purpose) and Domain 4 (Clarity of Presentation) with scores of 83% and 79%, respectively; the average Overall Assessment was 4.5 out of 7
The Royal College of Ophthalmologists (RCO) CPG scored lowest in Domain 6 (Editorial Independence) with 17% and highest in Domain 2 and Domain 4 with scores of 83% and 74%, respectively; the average Overall Assessment was 4 out of 7
Summary
Blindness caused by age-related macular degeneration (AMD) affects an estimated 32.4 million people worldwide, with an additional 191 million people suffering from moderate and severe AMD-related vision impairment [1]. It is critical to ensure that clinical practice guidelines (CPGs) for AMD abide by rigorous standards of development. Recent studies have reported significant shortcomings in the quality of CPGs, such as a failure to clearly delineate guideline methodology, poor evidence quality, and lack of conflict of interests disclosures among guideline development group members [2,3,4,5,6]. There has been no recent evaluation of CPGs for AMD. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument is a valid and reliable tool for assessing the methodological quality of CPGs [7,8,9].
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