ICO International Clinical Guidelines:

Introduction and News

Guidelines headlines:

• Guidelines now available as PDF files
  
  
• New ICO International Guideline on Trachoma
  
  
• Chinese define clinical practice guidelines
  
  
• Model for implementation of guidelines in other countries
  
  
• Other clinical guidelines available
  
  
• ICO Guidelines Committee requests other society guidelines
  
  
• Resources for Evidence-based Practice of Medicine
  
  
• 20 Guidelines available, more to come
  
  
• Pilot projects to increase awareness and use

(Also see: More News of Guidelines)

Guidelines now available as PDF files

The International Council of Ophthalmology's 20 International Clinical Guidelines can now all be downloaded as PDF files.

Download the complete set of 20 from www.icoph.org/pdf/ICOClinicalGuidlines.pdf (348 KB).

To download individual Guidelines, see www.icoph.org/guide/guidelist.html.

The Guidelines are designed to be translated and adapted by ophthalmologic societies to help ophthalmologists assess how they are treating patients. They are intended to serve a supportive and educational role and ultimately to improve the quality of eye care for patients.

New ICO International Guideline on Trachoma

A new ICO International Clinical Guideline on Trachoma has been added to the ICO Eye Site. The trachoma guideline can also be downloaded as a PDF file (100 KB).

The document was written by Tom Lietman, MD, from the Proctor Foundation in San Francisco, in consultation with Chan Dawson, MD, Hugh Taylor, MD, and others.

"We are aware that there may be disagreement with some of the recommendations, " commented ICO Guidelines Director Richard Abbott, MD. "Without evidence from clinical trials, we must rely on a consensus of expert opinion."

"It should be clear that any clinical guideline is directed towards populations of patients and may not specifically meet the needs of any individual patient," Dr. Abbott said. "In addition, even if followed exactly, clinical guidelines do not guarantee a successful outcome."

"Like our other 19 ICO International Clinical Guidelines, the trachoma Guideline is designed to be easy to read and to translate," Dr. Abbott said. "We hope that national ophthalmologic societies will adapt these guidelines for use by ophthalmologists in your countries."

Chinese define preferred practice patterns and guidelines

The Chinese Ophthalmological Society (COS) made its Preferred Practice Patterns and Process of Care Practice Guidelines available to members in a bound text at its third International Ophthalmology Congress in September in Beijing.

The COS Guidelines will be implemented first in hospitals and eye departments in the large cities in China.

Translation of 10 of the ICO’s International Clinical Guidelines into Chinese was the first step. That led to an initial workshop on defining practice guidelines for China in September 2004 and introduction of Guidelines to the ophthalmic community at the COS Congress in September 2005.

With the help of ICO Guidelines Director Richard Abbott, MD, and representatives of the World Health Organization and U.S. National Eye Institute, the COS has defined a formal evaluation protocol to assess the impact of the guidelines on training at selected medical centers and on ophthalmic practice and eye care in China.

Also see: more details on the development of clinical guidelines in China.

Model for implementation of guidelines in other countries

"The adaptation and implementation of clinical guidelines in China is an excellent model for other countries and regions," said Richard Abbott, MD, ICO Guidelines Director and Council Member.

India will initiate a process to define clinical guidelines in 2007.

Ophthalmologic societies interested in adapting or developing clinical guidelines may want to review Dr. Abbott's report on the Beijing workshops and the COS development process. The report can also be downloaded as PDF file (20 KB).

Other clinical guidelines available

Among other ophthalmology clinical guidelines available online are:

• Asia Pacific Glaucoma Guidelines (www.seagig.org/apgg.php) defined by the South East Asia Glaucoma Interest Group (SEAGIG)
  
  
• "Terminology and Guidelines for Glaucoma" from the European Glaucoma Society, which are available from www.eugs.org/ebook.asp
  
  
• Guidelines on cataract surgery, laser refractive surgery, diabetic retinopathy and other subjects from the Royal College of Ophthalmologists (www.rcophth.ac.uk/scientific/publications at the bottom of the page).

Committee requests other society guidelines

The ICO Clinical Guidelines Committee welcomes the submission of national, supranational and subspecialty society clinical guidelines for review and possible addition to or linking from the ICO Web site.

Send your clinical guidelines to Dr. Abbott at guidelines@icoph.org.

Resources for Evidence-based Practice of Medicine

The ICO Guidelines Committee has discussed the critical importance of practicing evidence-based medicine and of defining clinical guidelines based on evidence -- controlled clinical studies -- whenever possible.

Each practice recommendation in the ICO Clinical Guidelines is rated based on the strength of the evidence that supports it: Level I when there is strong evidence, Level II for substantial evidence and Level III when the recommendation is based only on consensus of expert opinion.

Part of the workshops on developing clinical guidelines in China focused on how to create evidence-based guidelines and incorporate them into practice.

Here are some helpful resources on evidence-based medicine:

• http://www.cebm.net (the Oxford Centre for Evidence-Based Medicine)
• http://www.cche.net (Centre for Health Evidence, in Canada)
• http://www.cochrane.org/index0.htm (the Cochrane Collaboration).

The 12^th Oxford Workshop on Teaching Evidence-Based Practice is September 11 to 15, 2006.

20 Clinical Guidelines available, more to come

There are now 20 Clinical Guidelines available, including one on Eye Disease in Leprosy (Initial evaluation and management). More are being developed covering the most prevalent eye conditions and diseases around the world.

The Guidelines are designed to help ophthalmologists assess how they are treating patients. They are intended to serve a supportive and educational role and ultimately to improve the quality of eye care for patients.

"We are attempting to keep the guidelines very practical, straight forward, and relevant to the performance and process of clinical care," according to ICO Guidelines Director, Richard L. Abbott, MD.

Pilot projects to increase awareness and use

The ICO Guidelines Committee is also considering other pilot projects to increase awareness and use of the International Clinical Guidelines by ophthalmologists who do not have Internet access or are unaware that they exist.

"We are attempting to keep the guidelines very practical, straight forward, and relevant to the performance and process of clinical care," according to ICO Guidelines Director, Richard L. Abbott, MD.

Next: More News of the guidelines

Also see: List of Guidelines