The AOA's Evidence-based Process

The AOA Evidence-based Optometry Committee has created a 14-Step process that aligns with the Institute of Medicine's recommendations for developing trustworthy clinical practice guidelines. Click on the links within this document to learn more about the process detail.

AOA's 14 Steps to Evidence-Based Clinical Practice Guideline Development

1. Guideline Development Group (GDG): The Evidence–Based Optometry (EBO) Committee selects a multidisciplinary panel of experts, including patient and public representatives, to act as the Guideline Development Group (GDG).
2. Transparency and COI: The GDG manages all conflict of interest (COI), which is documented by the AOA staff and reviewed during face to face meetings.
3. Clinical Questions*: The GDG defines the literature search criteria and defines all clinical questions through a Question Formulation Meeting.
4. Search for Evidence: The AOA Staff sends the search criteria and clinical questions for query (outside researchers) and provides all obtained papers to the Guideline Development Reading Group (GDRG). Systematic reviews, when available, are included in the guideline. There is no inclusion of Systematic Review (SR) writers in the GDG or GDRG. .
Inclusion Criteria (must meet all): English studies, study addresses the clinical question, paper meets the age group being addressed (0 to 18 years for pediatrics and 18 and beyond for adults).
Exclusion Criteria (meets any of the following): Non-English studies, animal studies, studies outside of the patient age range, studies not addressing any topic of the clinical questions searched.
5. Grade Evidence/Quality: Two members from the GDRG are randomly selected to read and grade each paper. They separately grade the paper for quality of evidence, based on a predetermined grading criteria, and state the clinical recommendation(s).
6. Articulate Clinical Recommendations/Strength*: The GDRG reviews all clinical recommendations and articulates each for inclusion in the guideline during an "Articulation of Recommendations" meeting(s). There are single and/or aggregate recommendations made and a strength level is assigned. Potential benefits and harms, costs, and patient preferences are identified, as well as any gaps in research and each is documented.
7. Write the Draft: The AOA Staff sends the Articulation results to the writer to develop draft 1.
8. Draft Review and Edits*: The GDG reads draft 1 and discusses and edits.
9. Rewrite/Final Drafts: The AOA Staff sends the draft results to the writer for writing/revisions for draft 2 (Peer Review Draft), and sends it to medical editor for copy editing. Additional reviews are completed as necessary.
10. Approval and Posting for Peer Review: The AOA Staff and/or the EBO Committee chair, sends the Peer Review Draft to the AOA Board of Trustees for approval to post for peer and public review. The draft is posted on the AOA website, the review period is announced, and comments are solicited.
11. Final Document Produced: The GDG reviews all peer comments and revises the final document. They may choose to include the peer review comment, not include the comment, and/or identify further gaps to review when preparing the next edition. All comments are documented regarding actions taken/not taken, and the Final Draft is produced.
12. Final Draft Approval and Legal Review: The final draft is sent to the AOA Board of Trustees and AOA Legal Counsel for approval and verification that the GDG followed the evidence-based process outlined by the National Academies of Sciences, Engineering, and Medicine (NASEM) - Health and Medicine Division (HMD) (previously the IOM).
13. Post Guidelines: The AOA Staff posts the evidence-based guideline to the AOA website and submits it to the National Guideline Clearinghouse for public use, accompanied by AOA’s written processes and completed documents.
14. Schedule Reviews: The GDG schedules a review to meet the NASEM guideline development standards and reviews all previously identified gaps in medical research and any new evidence, and revises the evidence-based guideline every 2 to 5 years.

** Denotes face-to-face meeting

For a downloadable copy of the 14 step process, please click here.