May 31, 2019 Conference
Dr. Benjamin Young, Yale University Department of Ophthalmology and Visual Sciences
Mr. Nicholas Apostolopoulos
Ramsey Yusuf, Yale School of Medicine
Purpose: Clinical practice guidelines (CPGs) are often published to provide clinicians with up to date, evidence based recommendations. We evaluated clinical practice guidelines (CPG) distributed by the Tear Film and Ocular Surface Society (TFOS), the Cornea External Disease and Refractive Society, and the American Academy of Ophthalmology (AAO) for the management of dry eyes. The evaluation was performed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument.
Methods: We conducted a literature search of CPGs of dry eye available to ophthalmologists and selected three. Four evaluators then independently appraised the CPGs with the AGREE II Instrument. The scores were presented on a 7point scale. Score were averaged under six domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability and Editorial Independence). We calculated standardized scores for each domain and overall quality as well as intraclass correlation coefficients to assess agreement between evaluators.
Results: Domain averages for the AAO guideline ranged between 51% to 89%; the CEDARS guideline between 42% and 93%; and 38% and 80% for the TFOS guideline. The intraclass correlation coefficients of the reliability of the score averages were AAO: 0.70 [0.39 – 0.88], CEDARS: 0.89 [0.76 – 0.95], and TFOS: 0.82 [0.63 – 0.93]. Overall, the three guidelines scored well on Scope and Purpose and Clarity of Presentation, and presented weaker in the domains of Stakeholder, Rigor of Development, and Applicability.
Conclusions: Dry eye management clinical practice guidelines could benefit from improvement in the domains of Stakeholder, Rigor of Development and Applicability.