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International Guidelines: All for One and One for All?

International Guidelines: All for One and One for All? Dr Okada1 has written an editorialin response to the international clinical guidelines being developed by theInternational Council of Ophthalmology (ICO), San Francisco, Calif. Dr Okadashould be commended for her broad understanding of the worldwide disparityof clinical practices due to social, cultural, economic, and geographic factors.With the ARCHIVES currently translated into languages on 5 continents, thisinsightful editorial will stimulate the global readers of the ARCHIVES tothink seriously about the issues raised. Dr Okada has brought to our attentionthe practice of acupuncture, herbs, homeopathy, therapeutic massage, and traditional"Oriental" medicine in different Asian communities, and she has rightly pointedout that the possible beneficial effects of these alternative medicines arenow being investigated by the National Center for Complementary and AlternativeMedicine at the National Institutes of Health, Gaithersburg, Md. In addition,she has correctly emphasized that diseases affected by genetic and environmentalfactors will exhibit different manifestations with varying clinical coursesin different parts of the world. However, there are several important issues misinterpreted by the author,such as the purpose, application, and eventual outcome of the ICO's internationalguidelines. 1. These guidelines are being developed as part of the Continuing MedicalEducational Program of the ICO.2 The guidelinesare meant to encourage ophthalmologists around the world to examine new evidencethat has come out of clinical trials in different geographic areas; the guidelinesare not to be imposed as minimal basic standards of appropriate eye care.The ICO realizes that the practice of ophthalmology should be regulated bylocal governments and influenced by local medical insurance systems, healthcare resources of the specific countries, available equipment, and practicesetting. The ICO in no way wishes to impose a standard or to enforce certainforms of clinical practices around the world. 2. At the Web site of the ICO, in the section of international clinicalguidelines, emphasis on "uniqueness of a patient and his or her particularcircumstances and physician judgment" has been made. The guidelines targetdisease processes occurring in populations of patients and not individualsin the general population. 3. The international clinical guidelines also provide different levelsof evidence of therapeutic approaches to the management of eye diseases. Asevidence continues to be gathered, the guidelines will continue to be revised.The preparation of the international clinical guidelines is therefore a dynamicprocess and does not set standards of practice. 4. While social, cultural, genetic, and environmental factors may influencethe manifestations and clinical courses of some eye diseases, the efficacyof certain therapeutic measures remains unchanged if the diseases are properlyclassified. So the international clinical guidelines may indirectly help tounify classification of eye diseases and provide support for clinical efficacyas defined by the clinical evidence. 5. While the international clinical guidelines have been adopted insimilar documents such as Preferred Practice Patterns3 of the American Academy of Ophthalmology, San Francisco,Calif, these documents are distinctly different in content and in expectationbecause the guidelines were carefully reviewed by the ICO Guidelines Committee,which has members from the 4 corners of the world. Furthermore, because DrOkada also serves as a member of the Committee of International Clinical Guidelines,she would certainly assist the ICO in producing clinical guidelines that befitthe education of the international ophthalmological community. 6. In these times of disturbed world peace, the ICO believes that educationis the cornerstone to improving international eye care. Education, not regulation,will bring all the peoples of the world together. In conclusion, the international guidelines are not "all for one andone for all" but "all for all"! Dr Tso is Vice President, Dr Abbott is International Guidelines Coordinator,and Dr Spivey is Secretary-General, the International Council of Ophthalmology,San Francisco, Calif. Correspondence: Dr Tso, Department of Ophthalmology, Johns HopkinsUniversity, 457 Woods Bldg, 600 N Wolfe St, Baltimore, MD 21287-9142 (matso@jhmi.edu). References 1. Okada AA International guidelines: all for one and one for all? Arch Ophthalmol. 2003;1211043- 1044PubMedGoogle ScholarCrossref 2. Duldulao ECed International Ophthalmology Strategic Plan to Preserveand Restore Vision: Vision for the Future: Proceedings of International Councilof Ophthalmology and Academia Ophthalmologica Internationalis. New York, NY International Council of Ophthalmology2001; 3. American Academy of Ophthalmology, Preferred Practice Patterns. San Francisco, Calif American Academy of Ophthalmology2003; http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

International Guidelines: All for One and One for All?

International Guidelines: All for One and One for All?

Abstract

Dr Okada1 has written an editorialin response to the international clinical guidelines being developed by theInternational Council of Ophthalmology (ICO), San Francisco, Calif. Dr Okadashould be commended for her broad understanding of the worldwide disparityof clinical practices due to social, cultural, economic, and geographic factors.With the ARCHIVES currently translated into languages on 5 continents, thisinsightful editorial will stimulate the global readers of the ARCHIVES tothink...
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Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.122.7.1090-d
Publisher site
See Article on Publisher Site

Abstract

Dr Okada1 has written an editorialin response to the international clinical guidelines being developed by theInternational Council of Ophthalmology (ICO), San Francisco, Calif. Dr Okadashould be commended for her broad understanding of the worldwide disparityof clinical practices due to social, cultural, economic, and geographic factors.With the ARCHIVES currently translated into languages on 5 continents, thisinsightful editorial will stimulate the global readers of the ARCHIVES tothink seriously about the issues raised. Dr Okada has brought to our attentionthe practice of acupuncture, herbs, homeopathy, therapeutic massage, and traditional"Oriental" medicine in different Asian communities, and she has rightly pointedout that the possible beneficial effects of these alternative medicines arenow being investigated by the National Center for Complementary and AlternativeMedicine at the National Institutes of Health, Gaithersburg, Md. In addition,she has correctly emphasized that diseases affected by genetic and environmentalfactors will exhibit different manifestations with varying clinical coursesin different parts of the world. However, there are several important issues misinterpreted by the author,such as the purpose, application, and eventual outcome of the ICO's internationalguidelines. 1. These guidelines are being developed as part of the Continuing MedicalEducational Program of the ICO.2 The guidelinesare meant to encourage ophthalmologists around the world to examine new evidencethat has come out of clinical trials in different geographic areas; the guidelinesare not to be imposed as minimal basic standards of appropriate eye care.The ICO realizes that the practice of ophthalmology should be regulated bylocal governments and influenced by local medical insurance systems, healthcare resources of the specific countries, available equipment, and practicesetting. The ICO in no way wishes to impose a standard or to enforce certainforms of clinical practices around the world. 2. At the Web site of the ICO, in the section of international clinicalguidelines, emphasis on "uniqueness of a patient and his or her particularcircumstances and physician judgment" has been made. The guidelines targetdisease processes occurring in populations of patients and not individualsin the general population. 3. The international clinical guidelines also provide different levelsof evidence of therapeutic approaches to the management of eye diseases. Asevidence continues to be gathered, the guidelines will continue to be revised.The preparation of the international clinical guidelines is therefore a dynamicprocess and does not set standards of practice. 4. While social, cultural, genetic, and environmental factors may influencethe manifestations and clinical courses of some eye diseases, the efficacyof certain therapeutic measures remains unchanged if the diseases are properlyclassified. So the international clinical guidelines may indirectly help tounify classification of eye diseases and provide support for clinical efficacyas defined by the clinical evidence. 5. While the international clinical guidelines have been adopted insimilar documents such as Preferred Practice Patterns3 of the American Academy of Ophthalmology, San Francisco,Calif, these documents are distinctly different in content and in expectationbecause the guidelines were carefully reviewed by the ICO Guidelines Committee,which has members from the 4 corners of the world. Furthermore, because DrOkada also serves as a member of the Committee of International Clinical Guidelines,she would certainly assist the ICO in producing clinical guidelines that befitthe education of the international ophthalmological community. 6. In these times of disturbed world peace, the ICO believes that educationis the cornerstone to improving international eye care. Education, not regulation,will bring all the peoples of the world together. In conclusion, the international guidelines are not "all for one andone for all" but "all for all"! Dr Tso is Vice President, Dr Abbott is International Guidelines Coordinator,and Dr Spivey is Secretary-General, the International Council of Ophthalmology,San Francisco, Calif. Correspondence: Dr Tso, Department of Ophthalmology, Johns HopkinsUniversity, 457 Woods Bldg, 600 N Wolfe St, Baltimore, MD 21287-9142 (matso@jhmi.edu). References 1. Okada AA International guidelines: all for one and one for all? Arch Ophthalmol. 2003;1211043- 1044PubMedGoogle ScholarCrossref 2. Duldulao ECed International Ophthalmology Strategic Plan to Preserveand Restore Vision: Vision for the Future: Proceedings of International Councilof Ophthalmology and Academia Ophthalmologica Internationalis. New York, NY International Council of Ophthalmology2001; 3. American Academy of Ophthalmology, Preferred Practice Patterns. San Francisco, Calif American Academy of Ophthalmology2003;

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Jul 1, 2004

Keywords: guidelines

References

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