Developing age-related macular degeneration recommendations for clinical optometrists via a modified Delphi study

Clear, evidence-based guidelines support optometrists in diagnosing and managing age-related macular degeneration, a leading cause of vision loss in older adults. This condition is an increasing focus of clinical care due to expanding treatment options and evolving imaging technologies.

Clinical practice guidelines support consistent, evidence-based care in optometry and play a critical role in guiding the diagnosis and management of chronic eye diseases. This paper discusses the methodological approach used to develop age-related macular degeneration guidelines, emphasising the modified Delphi approach used to refine and formally establish recommendations.

Recommendations were developed from a literature review and draft guideline. An expert working group of optometrists (n = 9) participated in a three-round Delphi process, rating their agreement with the draft recommendations using a 6-point Likert scale across two survey rounds, followed by a virtual meeting to discuss and re-vote on unclear or contentious items. Quantitative and qualitative measures during the first two rounds of the Delphi survey guided recommendation refinement and inclusion for discussion in round 3. Consensus for inclusion was defined as a mean score ≥5 and ≥80% agreement.

Out of 37 initial recommendations, 25 (68%) were accepted and included in the final guideline. Consensus was achieved for recommendations concerning clinical classification, assessment and management strategies. Round 3 discussions helped resolve uncertainties and refine recommendations wording, particularly regarding nutritional supplements and clinical biomarkers for progression. Adoption of the Delphi approach demonstrated the value of both quantitative and qualitative feedback.

The feasibility and value of using a modified Delphi method to develop optometric clinical practice guidelines is demonstrated. The process supported the inclusion or exclusion of recommendations in a systematic way with the final guideline offering contemporary, practice-relevant guidance for the diagnosis and management of age-related macular degeneration.