ICO International Clinical Guidelines:

Introduction to the Guidelines

On this page:

• Principles
  
  
• Ratings of importance to the care process
  
  
• Ratings of the strength of evidence
  
  
• Disclaimer from the American Academy of Ophthalmology

These are guidelines adapted from the American Academy of Ophthalmology's (AAO) summary benchmarks for the Preferred Practice Patterns™ (PPPs).

Principles

The AAO Preferred Practice Patterns series of guidelines has been written on the basis of three principles:

• Each Preferred Practice Pattern should be clinically relevant and specific enough to provide useful information to practitioners.
  
  
• Each recommendation that is made should be given an explicit rating that shows its importance to the care process.
  
  
• Each recommendation should also be given an explicit rating that shows the strength of evidence that supports the recommendation and reflects the best evidence available.

Preferred Practice Patterns provide guidance for the pattern of practice, not for the care of a particular individual.

While they should generally meet the needs of most patients, they cannot possibly best meet the needs of all patients.

Depending on a host of medical and social variables, it is anticipated that it will be necessary to approach some patients' needs in different ways. The ultimate judgment regarding the propriety of the care of a particular patient must be made by the physician in light of all of the circumstances presented by the patient.

Adherence to these Preferred Practice Patterns will certainly not ensure a successful outcome in every situation. These guidelines should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the best results.

For each major disease condition, recommendations for the process of care, including the history, physical exam and ancillary tests, are summarized, along with major recommendations for the care management, follow-up, and education of the patient.

For each PPP, a detailed literature search of MEDLINE for articles in the English language is conducted. The results are reviewed by an expert panel and used to prepare the recommendations, which they rated in two ways.

Ratings of importance to the care process

The panel first rated each recommendation according to its importance to the care process. This "importance to the care process" rating represents care that the panel thought would improve the quality of the patient's care in a meaningful way.

The ratings of importance are divided into three levels:

• Level A, defined as most important
  
  
• Level B, defined as moderately important
  
  
• Level C, defined as relevant but not critical.

Ratings of the strength of evidence

The panel also rated each recommendation on the strength of evidence in the available literature to support the recommendation made. The "ratings of strength of evidence" also are divided into three levels:

Level I provides strong evidence in support of the statement. The design of the study allowed the issue to be addressed, and the study was performed in the population of interest, executed in such a manner as to produce accurate and reliable data, and analyzed using appropriate statistical methods. The study produced either statistically significant results or showed no difference in results despite a design specified to have high statistical power and/or narrow confidence limits on the parameters of interest.

Level II provides substantial evidence in support of the statement. Although the study has many of the attributes of one that provides Level I support, it lacks one or more of the components of Level I.

Level III provides a consensus of expert opinion in the absence of evidence that meets Levels I and II.

Disclaimer from the American Academy of Ophthalmology

The International Council of Ophthalmology's International Clinical Guidelines have been adapted from material provided by the American Academy of Ophthalmology: http://www.aao.org.

The Academy is not responsible for any changes or additions to the original material.

The Academy provides its material for educational purposes only. It is not intended to represent the only or best method or procedure in every case, or to replace a physician's own judgment or give specific advice for case management.

Preferred patterns of practice may require modification to meet the needs and resources of individual patients, specific patient populations and geographic locations.

Including all indications, contraindications, side effects and alternative agents for each drug or treatment is beyond the scope of this material. All information and recommendations should be verified, prior to use, with current information included in the manufacturers' package inserts or other independent sources, and considered in light of the patient's condition and history.

Reference to certain drugs, instruments and other products is made for illustrative purposes only and is not intended to constitute an endorsement of such.

The Academy specifically disclaims any and all liability for injury or other damages of any kind, from negligence or otherwise, for any and all claims that may arise out of the use of any recommendations or other information contained herein.

Next: List of Guidelines

Also see: International Clinical Guidelines (Preface)