Glaucoma Clinical Guidelines

Abstract

We read with interest the article by Ou et al1Ou Y. Goldberg I. Migdal C. Lee P. A critical appraisal and comparison of the quality and recommendations of glaucoma practice guidelines.Ophthalmology. 2011; 118: 1017-1023Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar article appraising 3 primary open angle glaucoma (POAG) clinical practice guidelines. Evaluation using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument2AGREE CollaborationDevelopment and Validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project.Qual Saf Health Care. 2003; 12: 18-23Crossref PubMed Google Scholar showed poor scores in the domains of stakeholder involvement, applicability, and editorial independence. Good clinical guidelines aim to improve the quality of healthcare, with the potential to change the process of health care and improve clinical outcomes.However, we are not clear on how the evaluated guidelines were selected. In particular, the omission of the United Kingdom (UK) National Institute for Health and Clinical Excellence (NICE) clinical guidelines for diagnosis and management of POAG and ocular hypertension3National Institute of Health and Clinical ExcellenceCG85 Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension Full guideline. Methods Evidence and Guidance.http://guidance.nice.org.uk/CG85Date: April 2009Google Scholar in their study appears to be an oversight on the part of the authors. National Institute for Health and Clinical Excellence guidance is based on best evidence, uses a transparent and rigorous development process, is produced by professionals, patients, and the public, considers cost effectiveness and applicability in its recommendations and maintains editorial independence.There are clear similarities in the glaucoma definition, optic disc, and visual field assessment of the NICE guideline recommendations in comparison with those examined by Ou et al. Striking differences however arise from explicit considerations for patient preferences and local healthcare contexts. This is likely due to stakeholder involvement in every stage of the NICE guideline development process. Stakeholder involvement is key to successful development and implementation of guidelines. The tool becomes useful and used, as it reflects the needs and values of relevant stakeholders. Also different are the economic analysis and examination of service models in the NICE guidance. These factors address the applicability domain of the AGREE instrument and will facilitate implementation. In addition there is strict adherence to editorial independence by NICE with full and published declarations of interests for every guideline development group member at every individual meeting. In the event of any perceived conflict of interest individual group members are excluded from related discussions and decision making. In a health care environment where industry lobbying is widespread, these procedures ensure that the NICE guideline development process satisfies the AGREE requirement of editorial independence.Blindness from diagnosed glaucoma is preventable, and improving quality of care is an important step in tackling the burden of this disease. Therefore, poor scores in the stakeholder involvement, applicability, and independence domains are key considerations in the potential clinical impact of the guidelines. Despite convergence on a number of key recommendations, these may not necessarily translate into convergence on clinical practice and outcomes unless greater attention is paid to all the AGREE requirements. We read with interest the article by Ou et al1Ou Y. Goldberg I. Migdal C. Lee P. A critical appraisal and comparison of the quality and recommendations of glaucoma practice guidelines.Ophthalmology. 2011; 118: 1017-1023Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar article appraising 3 primary open angle glaucoma (POAG) clinical practice guidelines. Evaluation using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument2AGREE CollaborationDevelopment and Validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project.Qual Saf Health Care. 2003; 12: 18-23Crossref PubMed Google Scholar showed poor scores in the domains of stakeholder involvement, applicability, and editorial independence. Good clinical guidelines aim to improve the quality of healthcare, with the potential to change the process of health care and improve clinical outcomes. However, we are not clear on how the evaluated guidelines were selected. In particular, the omission of the United Kingdom (UK) National Institute for Health and Clinical Excellence (NICE) clinical guidelines for diagnosis and management of POAG and ocular hypertension3National Institute of Health and Clinical ExcellenceCG85 Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension Full guideline. Methods Evidence and Guidance.http://guidance.nice.org.uk/CG85Date: April 2009Google Scholar in their study appears to be an oversight on the part of the authors. National Institute for Health and Clinical Excellence guidance is based on best evidence, uses a transparent and rigorous development process, is produced by professionals, patients, and the public, considers cost effectiveness and applicability in its recommendations and maintains editorial independence. There are clear similarities in the glaucoma definition, optic disc, and visual field assessment of the NICE guideline recommendations in comparison with those examined by Ou et al. Striking differences however arise from explicit considerations for patient preferences and local healthcare contexts. This is likely due to stakeholder involvement in every stage of the NICE guideline development process. Stakeholder involvement is key to successful development and implementation of guidelines. The tool becomes useful and used, as it reflects the needs and values of relevant stakeholders. Also different are the economic analysis and examination of service models in the NICE guidance. These factors address the applicability domain of the AGREE instrument and will facilitate implementation. In addition there is strict adherence to editorial independence by NICE with full and published declarations of interests for every guideline development group member at every individual meeting. In the event of any perceived conflict of interest individual group members are excluded from related discussions and decision making. In a health care environment where industry lobbying is widespread, these procedures ensure that the NICE guideline development process satisfies the AGREE requirement of editorial independence. Blindness from diagnosed glaucoma is preventable, and improving quality of care is an important step in tackling the burden of this disease. Therefore, poor scores in the stakeholder involvement, applicability, and independence domains are key considerations in the potential clinical impact of the guidelines. Despite convergence on a number of key recommendations, these may not necessarily translate into convergence on clinical practice and outcomes unless greater attention is paid to all the AGREE requirements. A Critical Appraisal and Comparison of the Quality and Recommendations of Glaucoma Clinical Practice GuidelinesOphthalmologyVol. 118Issue 6PreviewTo appraise primary open-angle glaucoma (POAG) practice guidelines critically and to compare these guidelines' major recommendations. Full-Text PDF Author replyOphthalmologyVol. 119Issue 2PreviewWe would like to thank Dr. Yip and Dr. Sparrow for their thoughtful comments on our paper entitled, “A Critical Appraisal and Comparison of the Quality and Recommendations of Glaucoma Practice Guidelines.” Full-Text PDF