Assessment of the Methodological Quality of Glaucoma Clinical Practice Guidelines Using the AGREE II Instrument

Abstract

Objective: To evaluate and compare the methodological quality of the glaucoma clinical practice guidelines (CPGs) and to provide references and recommendations for glaucoma guidelines. Methods: The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used to assess the seven guidelines, including the AAO's Preferred Practice Pattern (PPP) in Primary Angle Closure (AAO-PAC), the AAO's PPP in Primary Open-Angle Glaucoma (AAO-POAG), the AAO's PPP in Primary Open-Angle Glaucoma Suspect (AAO-POAGS), the EGS's Terminology and Guidelines for Glaucoma (EGS), ICO Guidelines for Glaucoma Eye Care (ICO), and Asia Pacific Glaucoma Guidelines (APGG) and Consensus of Glaucoma: China (CG). Domain scores were compared and intraclass correlation coefficients (ICCs) and 95% confidence intervals (CI) were calculated. Results: The ICCs of the seven guidelines were above 0.9. In general, all the appraised guidelines scored favorably in domain 1 (Scope and Purpose) and domain 4 (Clarity of Presentation), whereas the other domains scored less favorably. The average scores of six domains involved in the included guidelines were 84%±19% (domain 1, Scope and Purpose), 37%±18% (domain 2, Stakeholder Involvement), 25%±25% (domain 3, Rigor of Development), 90%±16% (domain 4, Clarity of Presentation), 34%±10% (domain 5, Application), 40%±34% (domain 6, Editorial). The six domains' respective scores for AAO-POAGS were 99%, 42%, 61%, 97%, 41%, 77%, and for Consensus of Glaucoma: China were 47%, 4%, 8%, 57%, 17%, 0%. Conclusions: AAO-POAGS were strongly recommended among the seven guidelines. There was much room for Chinese glaucoma guidelines to improve in formulating more rigorous guidelines. Key words: practice guideline; quality evaluation; Appraisal of Guidelines for Research and Evaluation II; glaucoma