Evidence-based approach to Ophthalmic Practice

The need for critical thinking and an evidence-based approach in optometric practice is widely acknowledged. Several moves and publications illustrate this point. In 1997, the Cochrane Collaboration developed an arm known as the Cochrane Eyes and Vision Group http://eyes.cochrane.org/), aiming “to prepare, maintain and promote access to systematic reviews of all the interventions used to prevent or treat eye diseases and/or visual impairment [and to] consider the evidence for interventions that aim to help people adjust to visual impairment or blindness”. McBrien (1998) noted that the expanding clinical scope of optometry, with areas of expertise including behavioural optometry and ocular therapeutics, increases the importance of an evidence-based approach to optometric practice. In 1999, the journal Evidence-Based Ophthalmology was introduced, with a focus on “an evidence-based (as opposed to an anecdotal) approach to eye care. Rather than undertaking a given treatment because ‘that's how we treat this condition’” (however, the journal closed in 2011 because the “publisher wishes to provide continued support for evidence-based research in formats that reach larger audiences”). The first book focused specifically on evidence-based eye care was published in 2006 (Kertes and Johnson, 2006).

In 2003, the US-based Institute of Medicine (IOM) made recommendations for education programs in health care, including optometry. The IOM developed five core competencies for clinicians in all health care areas, and one of these directly called for an evidence-based approach to practice: “Use evidence-based practice: To integrate the best research with clinical expertise and patient values”. Based on these recommendations, Elam (2004) pointed to a need for competences not only for entry-level optometrists, but also for the mature practitioner, including competency in evidence-based practice. In Australia, the federal government’s National Eye Health Framework (Australian Government Department of Health and Ageing, 2005) states that “Improving the evidence base” for eye care is a key area for action. Another key area identified in the framework is “Improving the systems and quality of care” with specific action items on continuing professional development and training and the promotion of evidence-based guidelines for eye care. From September 2008, an MSc program in Evidence Based Practice in Ophthalmology has been offered by the University of Teeside, U.K. 

In a review focused in part on evidence in optometric practice, Adams (2007) reminds us that vision research is fundamental to optometry, underpinning every aspect of our practice. He also highlighted the importance of undergraduate and postgraduate education in optometry, to ensure that practitioners understand the principles of evidence-based eye care and have the skills needed to use this approach in their practice. As noted by Anderton (2007), it is essential for optometrists to be able to assess whether claims of statistical significance are justified, and to determine whether the findings have clinical significance. More recently, Elliott (2012) discusses the importance of evidence-based clinical decision-making, and points out that optometrists should not only be accessing and using best evidence, but could also contribute to the pool of evidence, based on clinical experience and patient data. Everything on the list below (and more) is well worth a read: 

Adams, A.J. (2007) The role of research, evidence and education in optometry: a perspective. Clin Exp Optom 90(4): 232-237.

Anderton, P.J. (2007) Implementation of evidence-based practice in optometry. Clin Exp Optom 90(4): 238-243.

Elam, J.H. (2004) Competency-based optometric education. Optometry 75(2): 75-78.

Elliott D.B. (2012) Evidence-based optometry and in-practice research. Ophthalmic Physiol Opt 32(2): 81-81.

Kertes, P.J. and Johnson, T.M. (2006) Evidence-based eye care. Lippincott, Williams and Wilkins.

McBrien, N. (1998) Optometry: an evidence-based clinical discipline. Clin Exp Optom (Editorial) 81(6): 234-235.