The Hoskins Center and Academy-approved Compendium of Evidence-Based Eye Care is a collection of practice guidelines based on clinical evidence and expert consensus. Academy guidelines are designed to facilitate clinician decision-making regarding the treatment of specific eye diseases. Clinical guidelines improve quality of care by decreasing inappropriate variation in patient care and expediting effective advances into everyday practice.

One challenge in medicine is making new information and evidence easily and readily available to busy practitioners as the volume of evidence is overwhelming. As a result, only 50 percent of patient care is based on evidence-based medicine. There is, on average, a 12-year lag for the adoption of results from randomized controlled trials into clinical practice. A key objective of the Hoskins Center’s Compendium of Evidence-Based Eye Care is making the results of the latest and most reliable clinical evidence readily accessible.

All Compendium guidelines are rated based on their importance to the care process and the strength of evidence in the available literature. The strength of evidence is indicated by two levels:

• Level I: Includes evidence obtained from at least one properly conducted, well-designed randomized controlled trial. It may include meta-analyses of randomized controlled trials.

NOTE: Level I guidelines are defined as the most important to the patient care process.

• Level III: 

1. Well-designed controlled trials without randomization
2. Well-designed cohort or case-controlled analytic studies, preferably from more than one center
3. Multiple-time series with or without the intervention

Includes evidence obtained from one of the following sources:

1. Descriptive studies
2. Case reports
3. Reports of expert committees/organizations (e.g., Preferred Practice Pattern® (PPP) guidelines panel consensus with peer review)

NOTE: Level III guidelines are defined as relevant, but not critical to the patient care process.

Sources for content in the Compendium include:

•  Hoskins Center and Academy-approved PPP Guidelines, Summary Benchmarks, and PPP Clinical Questions

•  Hoskins Center and Academy-approved Clinical Statements

•  Subspecialty society clinical guidelines and statements

•  Clinical trials

•  International societies (International Council on Ophthalmology)

•  Supranational societies and national societies

Academy Leaders participating in the creation of Compendium content must adhere to the financial disclosure requirements of the Identification and Resolution of Conflicts of Interest policy.

Guideline Formation Process

In order for a document to be included in the Hoskins Center’s Compendium for Evidence-Based Eye Care, a subspecialty society must initially create a committee for guideline development. This committee may include a member of the Academy’s Practicing Ophthalmologist Curriculum (POC) panel and a member of the PPP panel from the relevant subspecialty area. (In addition, any member may serve ex-officio to provide guidance to a committee.) The organized committee then:

1. Chooses disease entities, patient populations, and intervention(s) using the POC as the most clinically relevant source of potential guideline topics.
2. Creates a draft guideline document. (See the Compendium section on the Academy’s ONE Network for examples.)
3. *Performs a literature search that includes all relevant Academy educational products, subspecialty society (literature), and Cochrane reviews.
4. *Evaluates existing evidence and rates the quality of each study by a trained methodologist. (Society must provide funding or sponsorship for this activity.)
5. Modifies process of care elements and make recommendations based on available evidence and panel consensus.
6. Works within subspecialty society to refine the guideline and consider comments.

The Preferred Practice Pattern® panel and Academy staff will review the guideline content and methodology. If approved, the guideline is subsequently forwarded to the Academy’s Board of Trustees. Only upon Board approval -- via the consent agenda -- are guidelines added to the Compendium.

*NOTE: Steps 3 and 4 are optional, but NECESSARY for evidence-based, Level I guidelines.*

Framework for Guideline Content

• Diagnosis (clinical and lab)

• Risk factors

• Differential diagnosis

• Management (medical, surgical, and follow-up)

• Treatment complications (prevention and management)

• Disease-related complications

• Patient instructions

Publication

When guidelines are approved for the Compendium, they are ultimately published on the Academy’s ONE Network and linked to a ONE subspecialty page. The guidelines are then reviewed and/or updated on a regular basis to remain current and relevant to the practice of ophthalmology (typically every 3–5 years). The Hoskins Center works with subspecialty societies on the updating process. Societies will be asked to appoint a representative to work collaboratively with the Hoskins Center.

International Ophthalmology Organizations