Trustworthiness of Best Practice Guidelines for Management of Patients With Cataracts
Narrative Responses:
Purpose
To determine the adherence of the American Academy of Ophthalmology’s (AAO) Preferred Practice Pattern (PPP) guidelines for the management of cataracts in the adult eye to the Institute of Medicine’s (IOM) standards for trustworthy clinical practice guidelines.
Methods
The authors (BKY, CEM, PBG) examined the AAO, Cataract in the Adult Eye, PPP document for adherence to the eight 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
Two of the eight AAO PPP standards for cataract treatment passed: Systematic Review and Updating; and six did not: Establishing Transparency, Management of Conflict of Interest, Guideline Development Group Composition, Establishing Evidence Foundations, Articulation of Recommendation, and External Review. Notably, patients or patient advocates were not ostensibly involved in the development or review of this PPP, evidence foundations were not consistently rated and clinical guidelines were not well-articulated.
Conclusion
The AAO PPP guidelines for cataract management would not be considered trustworthy by IOM standards. The PPP can be revised to meet the IOM standards by involving patients in the formation of guidelines, ensuring evidence ratings are consistently applied and clarifying recommendations for care.