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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EGlaucoma affects about 60.5 million people globally and is the second leading cause of blindness. A study examining 3 separate clinical practice guidelines governing primary open-angle glaucoma found that all 3 sets of guidelines require improvements.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOphthalmology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EGlaucoma\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOphthalmology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOphthalmology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EGlaucoma\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EA study examining 3 separate clinical practice guidelines governing primary open-angle glaucoma found that all 3 sets of guidelines require improvements, stated Annie Wu, MD, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EGlaucoma affects about 60.5 million people globally and is the second leading cause of blindness [Quigley HA, Broman AT. \u003Cem\u003EBr J Ophthalmol\u003C\/em\u003E. 2006]. Although rigorous clinical practice guidelines are necessary for glaucoma, there are obstacles that can color the rigor of guidelines, including conflict of interest and quality of the evidence [Kung J et al. \u003Cem\u003EArch Intern Med.\u003C\/em\u003E 2012; Ransohoff DF et al. \u003Cem\u003EJAMA\u003C\/em\u003E. 2013].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe present study evaluated the quality of guidelines for primary open-angle glaucoma published in recent years by the American Academy of Ophthalmology (AAO) [AAO Glaucoma Panel, Primary Open-Angle Glaucoma Preferred Practice Patterns, 2010], Canadian Ophthalmological Society (COS) [COS, \u003Cem\u003ECan J Ophthalmol\u003C\/em\u003E. 2009], and the National Institute for Health and Care Excellence (NICE) [National Collaborating Center for Acute Care. Glaucoma: Diagnosis and management of chronic open-angle glaucoma and ocular hypertension. London (UK), 2009].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EFour evaluators independently appraised each set of guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool [Brouwers M et al. \u003Cem\u003ECMAJ\u003C\/em\u003E. 2010]. AGREE II contains 6 domains: Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence. The overall assessment score across all domains uses a 7-point scale; a score of 7 indicates 100% adherence to the particular guideline.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EApplication of AGREE II-produced scores ranged from 28% to 85% for the AAO guidelines, 51% to 96% for the COS guidelines, and 55% to 97% for the NICE guidelines. Scope and Purpose was the strongest domain for all 3 sets of guidelines. Clarity of Presentation was a strong domain for the COS and NICE guidelines. The weakest domains were Editorial Independence for all 3 guidelines, and Stakeholder Involvement for the AAO and COS guidelines.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EComparison of the AGREE II evaluation of the 3 guidelines revealed variability that sometimes could be considerable between the individual guideline domain scores; for example, scores for the Stakeholder Involvement domain varied from 28% for the AAO guidelines to 79% for the NICE guidelines (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15505\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15505\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15505\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EComparison of AGREE II Scores in Evaluation of Glaucoma Guidelines\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EThe overall assessment favored the NICE guidelines, followed by the COS and AAO guidelines. The results of the study have prompted several primary and additional recommendations.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EPrimary recommendations concerned clarifying stakeholder involvement, using a guideline development process that is transparent and rigorous, and acknowledging competing interests and their possible influence.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EThe researchers concluded that the use of the AGREE II assessment instrument revealed shortcomings in methodologies in all 3 association guidelines in the domains of Stakeholder Involvement, Rigor of Development, and Editorial Independence. This appraisal highlights the importance of regularly assessing clinical practice guidelines. Such a regular assessment, and the resulting improvements, will result in meaningful recommendations for clinical practice.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/43\/9.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzoisd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzoisd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}