A critical appraisal and comparison of the quality and recommendations of glaucoma clinical practice guidelines

Purpose: To appraise primary open-angle glaucoma (POAG) practice guidelines critically and to compare these guidelines' major recommendations.

Design: Evaluation of clinical practice guidelines and their development process.

Participants: Glaucoma fellowship-trained ophthalmologists.

Methods: The POAG clinical practice guidelines published by the American Academy of Ophthalmology (AAO), European Glaucoma Society (EGS), and South East Asia Glaucoma Interest Group (SEAGIG) were evaluated by independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.

Main outcome measures: Domain scores using the AGREE instrument.

Results: Critical appraisal using the AGREE instrument demonstrated that the AAO guidelines scored favorably (>60%) in the domains of scope and purpose, rigor of development, and clarity and presentation, while scoring unfavorably (<60%) in the domains of stakeholder involvement, applicability, and editorial independence. The Terminology and Guidelines for Glaucoma and the Asia Pacific Glaucoma Guidelines respectively developed by EGS and SEAGIG scored favorably in the domains of scope and purpose and clarity and presentation, but scored unfavorably in the domains of stakeholder involvement, applicability, and editorial independence. The major recommendations regarding diagnosis and management of POAG were similar among the 3 guidelines, although the level of detail varied considerably.

Conclusions: Although the clinical practice guidelines from the AAO, SEAGIG, and EGS have contributed to developing evidence-based guidelines for glaucoma management, there is variability in the quality of the guideline development process and how it is reported as evaluated by a standardized instrument. The adoption of common standards in developing clinical practice guidelines in ophthalmology should improve their consistency and quality.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.