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September 1996

The Dilemma of Practice Guideline Development

Author Affiliations

New York, NY

Arch Ophthalmol. 1996;114(9):1128. doi:10.1001/archopht.1996.01100140330013

Ophthalmologists are facing a dilemma concerning the justification of pursuing technological advances in an environment where a premium is placed on considerations of cost-effectiveness and clinical needs. The consequences of this issue are highlighted in the recent editorial by O'Day1 and the Letter to the Editor by Masket.2 The opinions expressed by each of these knowledgeable and concerned ophthalmologists emphasize the conflict that the current debate in health system reform has engendered. A major concern is that individuals who possess little understanding of eye care will become the arbiters and decision makers in developing guidelines for the management of ophthalmologic conditions. Ophthalmology has assumed a proactive, leadership role in guideline development and outcome assessment to head off this possibility. However, the struggle to reconcile the clinical value of emerging technology and prove its clinical effectiveness remains a daunting challenge.

Although most physicians view the concept of guidelines with

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