Table 2

Summary of appraisers’ comments organised by Appraisal of Guidelines Research and Evaluation (AGREE II) domains on the adult cataract clinical practice guidelines (CPG) developed by the American Academy of Ophthalmology (AAO), the Canadian Ophthalmological Society (COS) and the Royal College of Ophthalmologists (RCO)*

AGREE II domainStrengthsWeaknesses
1. Scope and PurposeTarget patient population is clearly specified
Objectives are clearly stated
Specific health questions are not clearly stated or thoroughly described
2. Stakeholder InvolvementContains brief statement of Lay Advisory Group involvement (RCO)
GDG members’ names, disciplines, institutions and geographical locations are clearly listed and easy to locate (RCO)
No statement of type of strategy used to capture views and preferences of the patients/public (AAO, COS)
No description of feedback gathered from patient representatives and how the information shaped recommendation formulation
3. Rigour of DevelopmentDetailed search terms are provided online (AAO)Evidence search terms mention database and time periods searched, but lack search terms and full search strategy (COS, RCO)
The ‘Highlighted Findings’ detail health benefits, risks, side effects and costs for potential complications should the guidelines not be followed (AAO)No description of recommendation formulation process or how development process influenced recommendations
Recommendations are preceded by a section detailing pertinent evidence; each recommendation cites a primary source (COS)No details of external review methods, description of external reviewers, outcomes/info gathered from external review or how the info gathered was used to inform development
Recommendations are graded according to NICE definitions; each recommendation is preceded by a box containing evidence grade (RCO)No detailed methodology for updating the CPG (COS, RCO)
4. Clarity of PresentationEleven key recommendations are clearly indicated under ‘Highlighted Findings and Recommendations for Care’ (AAO)Long passages without clear formatting make it difficult to identify recommendations within the main text (AAO)
Recommendations are numbered, listed first in each subsection, proceeded directly by strength of evidence rating and citations (COS)Recommendation wording is poor: sometimes use language such as ‘techniques commonly used are’ instead of providing a concise, actionable recommendation (AAO)
Recommendations are flagged via boxes in the left margin featuring ratings for evidence strength (RCO)
5. ApplicabilityContains section on socioeconomic considerations, and subsections on cost effectiveness and cost considerations (AAO)Implementation section lacks a summary document of the key recommendations, algorithms and surgical checklists
Includes thorough monitoring and auditing criteria (COS)Resource implications not covered: no identification of the methods by which cost information was sought, description of cost information, and how it informed the guideline development process (COS)
Discussion on outsourcing cataract surgery includes consideration of problems for the provider, local eye unit and commissioner (RCO)
6. Editorial IndependenceIndependence of funding body clearly stated (AAO, COS)
Competing interests are named and categorised by type (AAO, COS)
The PPP review panel was free of COI (AAO)
At least half the PPP panel, PPP consulting work group, and PPP committee members had potential financial COI (AAO)
No explicit financial disclosures for GDG members (RCO)
No mention of funding body (RCO)
No explanation of methods by which potential competing interests were sought, description of the competing interests, and how they influenced the recommendations
  • *Comments specific to certain CPGs are indicated in parentheses; comments lacking denotations pertain to all three CPGs.

  • GDG, guideline development group; NICE, National Institute for Health and Care Excellence; COI, conflict of interest; PPP, preferred practice pattern.