Patient-Reported Outcome Measure Usage in Guidelines Published by the American Academy of Ophthalmology - a Review

• Published in: Ophthalmology (Rochester, Minn.)
• Main Authors: Yu, Caberry W, Nanji, Keean, Hatamnejad, Amin, Gemae, Mohamed, Joarder, Ishraq, Achunair, Abhishek, Devji, Tahira, Phillips, Mark, Zeraatkar, Dena, Steel, David H, Guymer, Robyn H, Sivaprasad, Sobha, Wykoff, Charles C, Chaudhary, Varun
• Format: Journal Article
• Language: English
• Published: United States 08.07.2023
• ISSN: 1549-4713

To review the use of patient-reported outcome measures (PROMs) in the treatment of ophthalmologic conditions as recommended by the clinical practice guidelines (CPGs) published by the American Academy of Ophthalmology (AAO). PROMs are standardized instruments that provide information regarding a patient's health status or health-related quality of life. PROMs are increasingly used to inform study endpoints in ophthalmology studies. However, the extent to which PROMs are ultimately informing patient management recommendations in ophthalmology as part of CPGs remains an area of evidence gap. We included all CPGs published by the AAO from inception to June 2022. We also included all primary studies and systematic reviews cited in the treatment sections of the CPGs evaluating treatment of an ophthalmic condition. The primary outcome was the frequency of PROMs discussed in CPGs and in cited studies evaluating treatment. Secondary outcomes included frequency of minimal important difference (MID) usage to contextualize PROM results and percentage of strong and discretionary recommendations supported by PROMs. We published a study protocol a priori on PROSPERO (CRD42022307427). Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. We assessed risk of bias using the Appraisal of Guidelines, Research and Evaluation (AGREE II) instrument. We identified 24 eligible CPGs, providing 2458 cited studies (2191 primary, 267 secondary) evaluating treatment of eye conditions. Ten CPGs (41.7%) reported consideration of PROMs. Of these, 31/94 (33%) of recommendations were informed by studies evaluating a PROM as an outcome. Across all studies cited in the development of CPGs, 221 studies (9.0%) used PROMs as a primary or secondary outcome, of which 4 PROM results (1.8%) were interpretated using an empirically-determined MID. Overall, the risk of bias was low for all CPGs. Overall, outcomes of PROMs are seldom used in ophthalmology CPGs published by the AAO and in cited primary and secondary research on treatments. When PROMs were considered, their interpretation was seldom based on a MID. To improve patient care, guideline developers may consider incorporating PROMs and applicable MIDs to inform key outcomes when formulating treatment recommendations.