Developing specialty-wide standards of practice: the experience of ophthalmology

In 1986, the American Academy of Ophthalmology (AAO) developed national guidelines for the diagnosis and treatment of major eye disease. A core committee of 10 AAO members detailed the framework and goals for the guidelines and wrote a series of broad criteria outlining the ophthalmologist's moral and ethical responsibilities. Several panels of AAO-physician experts were formed to develop guidelines for specific conditions. The panels were formed according to subspecialty and were assigned well-defined issues, such as the diagnosis and management of chronic, adult-onset open-angle glaucoma. Process and structure standards were developed first; outcome standards are scheduled for future development. The first five sets of practice guidelines have been approved by the AAO's Governing Council. These include standards for the comprehensive eye exam, as well as four disease-specific guidelines--open-angle glaucoma, glaucoma suspect, diabetic eye disease, and cataract.