Trustworthiness of Best Practice Guidelines for Management of Primary Open-Angle Glaucoma
Narrative Responses:
Purpose
To evaluate the adherence of the American Academy of Ophthalmology’s “Primary Open-Angle Glaucoma” Preferred Practice Pattern® guidelines (AAO POAG PPP) to the eight standards outlined by the Institute of Medicine (IOM).
Methods
The authors (AW, CW, and BKY) analyzed the main text of the AAO POAG PPP using IOM standards. A standard was deemed “pass” if all of its criteria were met. If neither the AAO website nor the PPP document contained information required by a standard, the standard was considered “failed.” Discrepancies were resolved by discussion amongst all authors.
Results
The POAG PPP passed three of the eight IOM standards (“Evidence Foundations”, “Articulation of Recommendations,” and “Updating”); it failed the remaining five (“Transparency”, “Conflict of Interest”, “Development Group Composition”, “Clinical Practice Guideline-Systematic Review Intersection”, and “External Review”).
Conclusion
The POAG PPP is not considered trustworthy by IOM standards. We recommend revisions with regard to management of conflict of interest, formulation of a diverse guideline development group, and clear documentation of the external review process to make this guideline a more useful tool for practicing ophthalmologists.