Change Healthcare Clinical Evidence Classification
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1 InterQual Specialty Referral Criteria: Eye Disorders Bibliography Change Healthcare Clinical Evidence Classification References cited in the clinical content are classified according to the type of evidence presented. The class ratings, I through V, are intended to provide a classification of the evidence but are not necessarily hierarchical. Classifications appear in parentheses at the end of each reference. References followed by an (NC) are not classified; examples include pre-published research or information from government, manufacturer, laboratory, or patient education websites. Classification Class I Class II Class III Class IV Class V Type of Evidence Meta-analysis, technology assessment, or systematic review Randomized controlled trial Observational or epidemiologic study Evidence-based guideline Expert opinion, panel consensus, literature review, text or reference book, descriptive study, case report, or case series Class I Class I sources synthesize the results of multiple studies. When quantitative synthesis is possible, meta-analyses can provide a more accurate estimate of the effect or association size than individual smaller studies can. A Class I study that finds insufficient evidence to support or refute an intervention (due to a lack of appropriate primary research) is inconclusive. A potential weakness of Class I studies is that they may only assess published research, potentially leaving their findings vulnerable to publication bias Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 1
2 Class II A randomized controlled trial (RCT) is an experimental study design in which subjects are randomly assigned to an intervention or a control group. An RCT is the gold standard for testing cause and effect relationships. Intention-to-treat analysis should be performed to account for missing data points. Class III Observational or epidemiologic studies can suggest an association between events or findings. These associations cannot be used to establish causality. Cross-sectional, cohort, and casecontrol studies are all used to identify possible risk factors. Cross-sectional studies are also used to determine the prevalence of a condition. Cohort studies are used to study incidence, the natural history of a condition, prognosis after a specific exposure, and associated harms. Nonrandomized controlled trials are sometimes used when randomization is impossible or unethical. Class IV Evidence-based guidelines are systematically developed recommendations for clinical practice. Evidence-based guidelines identify the methodology used to gather the evidence on which the recommendations are based. Usually, a grading system for both the quality of the evidence and the strength of the recommendations is provided. Guidelines that are evidencebased may also contain consensus recommendations in areas where evidence is lacking, but these recommendations are clearly identified and appropriately graded. Class V Class V references may be the best information in the absence of other evidence. Expert opinion, panel consensus, literature reviews, and descriptive studies (case reports or case series) are subject to significant bias. A case series with comparison to historical controls can be plagued with missing data, and data extraction inconsistencies are common. The use of historical controls does not address how the diagnosis of disease or its treatment has evolved over time with newer technologies or medication. Text book information may be out of date by the time the book is published. Comparative Effectiveness Research (CER) Citations are designated with the CER label as part of the evidence classification if the article cited is one of the following: 1. A clinical trial or other clinical study that directly compares two or more health care interventions for the same clinical scenario. 2. A systematic review that compares two or more health care interventions by synthesizing the research from previous clinical studies Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 2
3 Bibliography Abraham et al. The new epidemiology of cataract. Ophthalmol Clin North Am (4): (V) Actis et al. Eyelid benign and malignant tumors: issues in classification, excision and reconstruction. Minerva Chir (6 Suppl 1): (V) Allen et al. Inhaled corticosteroids: past lessons and future issues. J Allergy Clin Immunol (3 Suppl):S1-40. (V) American Academy of Ophthalmology. Bacterial Keratitis Preferred Practice Pattern Guidelines. San Francisco, CA: American Academy of Ophthalmology,; American Academy of Ophthalmology. Comprehensive Adult Medical Eye Evaluation Preferred Practice Pattern Guidelines. San Francisco, CA: American Academy of Ophthalmology,; American Academy of Ophthalmology. Conjunctivitis Preferred Practice Pattern Guidelines. San Francisco, CA: American Academy of Ophthalmology, American Academy of Ophthalmology. Dry Eye Syndrome Preferred Practice Pattern Guidelines. San Francisco, CA: American Academy of Ophthalmology,; American Academy of Ophthalmology. Guidelines for appropriate referral of persons with possible eye diseases Policy Statement. San Francisco, CA: American Academy of Ophthalmology,; American Academy of Ophthalmology. Preferred Practice Pattern: Blepharitis; American Academy of Ophthalmology. Preferred Practice Pattern: Cataract in the Adult Eye. San Francisco (CA): American Academy of Ophthalmology; American Academy of Ophthalmology. Preferred Practice Pattern: Diabetic Retinopathy: American Academy of Ophthalmology; American Academy of Ophthalmology. Primary Angle Closure Preferred Practice Pattern Guidelines. San Francisco, CA: American Academy of Ophthalmology,; American Academy of Ophthalmology. Primary Open-Angle Glaucoma Preferred Practice Pattern Guidelines. San Francisco, CA: American Academy of Ophthalmology American Academy of Ophthalmology. Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern Guidelines. San Francisco, CA: American Academy of Ophthalmology,; American Academy of Ophthalmology. Retina Panel. Posterior vitreous detachment, retinal breaks, and lattice degeneration. Preferred Practice Pattern Guidelines. San Francisco, CA: American Academy of Ophthalmology; American Academy of Ophthalmology Age-Related Macular Degeneration Preferred Practice Pattern Guidelines.. San Francisco, CA: American Academy of Ophthalmology; American Academy of Ophthalmologyl. Diabetic Retinopathy Preferred Practice Pattern Guidelines. San Francisco, CA: American Academy of Ophthalmology; American Diabetes Association. Diabetic retinopathy. Diabetes Care Suppl 1:S Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 3
4 American Optometric Association. Care of patient with anterior uveitis Optometric Clinical Practice Guideline. St. Louis, MO: American Optometric Association, Reviewed 2010 American Society of Plastic Surgeons. Practice Parameter for Blepharoplasty. Arlington Heights, IL: Available from: [cited October ]. (V) Boboridis and Bunce. Interventions for involutional lower lid entropion. Cochrane Database Syst Rev 2011(12):CD (I) Boscia. Current approaches to the management of diabetic retinopathy and diabetic macular oedema. Drugs (16): (I) Brown et al. Advanced laceration management. Emerg Med Clin North Am (1): (V) Cahill et al. Functional indications for upper eyelid ptosis and blepharoplasty surgery: a report by the American Academy of Ophthalmology. Ophthalmology (12): (I) Chaudhry et al. Orbital pseudotumor: distinct diagnostic features and management. Middle East Afr J Ophthalmol (1): (III) Cobb and Lloyd. Orbital Fractures. The BMJ Publishing Group Ltd.,; Available from: [cited Jun ]. (V) Cremers and Janjua. Periorbital and orbital cellulitis,. London: The BMJ Publishing Group Ltd.,; Available from: [cited Jun ]. Danese et al. Extraintestinal manifestations in inflammatory bowel disease. World J Gastroenterol (46): (V) Eliasoph. Current techniques of entropion and ectropion correction. Otolaryngol Clin North Am (5): (V) Felekis et al. Spectrum and frequency of ophthalmologic manifestations in patients with inflammatory bowel disease: a prospective single-center study. Inflamm Bowel Dis (1): (III) Gabbe et al. Obstetrics: Normal and Problem Pregnancies, 5th ed. Philadelphia, PA: Churchill Livingstone/Elsevier; (V) Gale and Varga. Uveitis. London: British Medical Journal; Available from: [cited June ] (V) Ghoneim et al. Preoperative subconjunctival injection of mitomycin C versus intraoperative topical application as an adjunctive treatment for surgical removal of primary pterygium. Middle East Afr J Ophthalmol (1): (II) Goawalla and Lee. A prospective randomized treatment study comparing three treatment options for chalazia: triamcinolone acetonide injections, incision and curettage and treatment with hot compresses. Clin Experiment Ophthalmol (8): (II CER) Khakshoor et al. Preoperative subpterygeal injection vs intraoperative mitomycin C for pterygium removal: comparison of results and complications. Am J Ophthalmol (2): (II) Lindsley et al. Interventions for acute internal hordeolum. Cochrane Database Syst Rev 2013(4):CD (I) Lindsley et al. Interventions for chronic blepharitis. Cochrane Database Syst Rev 2012(5):CD (I) 2018 Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 4
5 McIntosh et al. Interventions for branch retinal vein occlusion: an evidence-based systematic review. Ophthalmology (5): (I CER) Mendenhall and Lessner. Orbital pseudotumor. Am J Clin Oncol (3): (V) Mueller and McStay. Ocular infection and inflammation. Emerg Med Clin North Am (1):57-72, vi. (V) Murtha and Stasheff. Visual dysfunction in retinal and optic nerve disease. Neurol Clin (2): (V) Naradzay and Barish. Approach to ophthalmologic emergencies. Med Clin North Am (2): , vii-viii. (V) National Collaborating Centre for Acute Care. Glaucoma Diagnosis and management of chronic open angle glaucoma and ocular hypertension. London: National Institute for Health and Clinical Excellence (NICE); National Institute for Health and Clinical Excellence (NICE). Interventional procedure overview of implantation of multifocal (non-accommodative) intraocular lenses during cataract surgery. London: International Procedures Programme, NICE; Robinson et al. Investigation and management of adult periorbital and orbital cellulitis. J Laryngol Otol (6): (III) Slutsky and Jones. Periocular cutaneous malignancies: a review of the literature. Dermatol Surg (4): (I) Smith et al. Evaluation of red eye. London: The BMJ Publishing Group Ltd.,; Available from: [cited Jun ]. (V) Sodhi et al. Recent trends in the management of rhegmatogenous retinal detachment. Surv Ophthalmol (1): (II) The College of Optometrists. Cellulitis preseptal and orbital. In: The College of Optometrists, Clinical Management Guidelines; Wang et al. Device-modified trabeculectomy for glaucoma. Cochrane Database Syst Rev 2015(12):CD (I CER) Yanoff et al. Ophthalmology, 3rd edn. St. Louis, MO: Mosby; (V) 2018 Change Healthcare, LLC and/or its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 5
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