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Original Investigation
April 12, 2018

Identification and Description of Reliable Evidence for 2016 American Academy of Ophthalmology Preferred Practice Pattern Guidelines for Cataract in the Adult Eye

Author Affiliations
  • 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 3Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
  • 4Department of Epidemiology, University of Michigan, Ann Arbor
  • 5American Academy of Ophthalmology, San Francisco, California
  • 6Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
JAMA Ophthalmol. Published online April 12, 2018. doi:10.1001/jamaophthalmol.2018.0786
Key Points

Question  Which systematic reviews are reliable to inform the update of the American Academy of Ophthalmology’s Preferred Practice Pattern guidelines on cataract in the adult eye?

Findings  In a cross-sectional study, 99 systematic reviews on cataract in the adult eye were identified, and 46 (46%) were classified as reliable using prespecified criteria. All 46 reliable reviews were cited in the 2016 update of the Preferred Practice Pattern guidelines.

Meaning  The partnership between Cochrane Eyes and Vision US Satellite and the American Academy of Ophthalmology facilitated access to reliable systematic review evidence to support the development of clinical practice guidelines for cataract in the adult eye.

Abstract

Importance  Trustworthy clinical practice guidelines require reliable systematic reviews of the evidence to support recommendations. Since 2016, the American Academy of Ophthalmology (AAO) has partnered with Cochrane Eyes and Vision US Satellite to update their guidelines, the Preferred Practice Patterns (PPP).

Objective  To describe experiences and findings related to identifying reliable systematic reviews that support topics likely to be addressed in the 2016 update of the 2011 AAO PPP guidelines on cataract in the adult eye.

Design, Setting, and Participants  Cross-sectional study. Systematic reviews on the management of cataract were searched for in an established database. Each relevant systematic review was mapped to 1 or more of the 24 management categories listed under the Management section of the table of contents of the 2011 AAO PPP guidelines. Data were extracted to determine the reliability of each systematic review using prespecified criteria, and the reliable systematic reviews were examined to find whether they were referenced in the 2016 AAO PPP guidelines. For comparison, we assessed whether the reliable systematic reviews published before February 2010 the last search date of the 2011 AAO PPP guidelines were referenced in the 2011 AAO PPP guidelines. Cochrane Eyes and Vision US Satellite did not provide systematic reviews to the AAO during the development of the 2011 AAO PPP guidelines.

Main Outcomes and Measures  Systematic review reliability was defined by reporting eligibility criteria, performing a comprehensive literature search, assessing methodologic quality of included studies, using appropriate methods for meta-analysis, and basing conclusions on review findings.

Results  From 99 systematic reviews on management of cataract, 46 (46%) were classified as reliable. No evidence that a comprehensive search had been conducted was the most common reason a review was classified as unreliable. All 46 reliable systematic reviews were cited in the 2016 AAO PPP guidelines, and 8 of 15 available reliable reviews (53%) were cited in the 2011 PPP guidelines.

Conclusions and Relevance  The partnership between Cochrane Eyes and Vision US Satellite and the AAO provides the AAO access to an evidence base of relevant and reliable systematic reviews, thereby supporting robust and efficient clinical practice guidelines development to improve the quality of eye care.

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