Empowering optometrists with evidence: The American Academy of Optometry and Cochrane Eyes and Vision Educational Program

As the world grapples with an overwhelming influx of data, the need for evidence-informed health care has never been more critical. Celebrating its 22nd year, the Cochrane Eyes and Vision US Project (CEV@US) remains at the forefront of this effort, dedicated to enhancing vision care through rigorous systematic reviews.1 Founded in 2002 by the National Eye Institute, CEV@US is a pivotal arm of Cochrane, an international organization renowned for its commitment to synthesizing health care literature. By preparing systematic reviews—highly structured evaluations of evidence—CEV@US addresses key clinical questions related to eye health and visual impairment.1 Its mission is to ensure that interventions for preventing, diagnosing, and treating eye conditions are based on the best available evidence.1 The American Academy of Optometry (AAO) shares a parallel mission with CEV@US, rooted in the advancement of evidence-based optometric practice.2 The Academy is dedicated to promoting the art and science of vision care through lifelong learning, ensuring that practitioners are equipped with the latest research and clinical insights.2 Since 2021, the AAO and CEV@US have partnered to build a robust educational program to enhance evidence-based clinical practice among optometrists and establish the Academy as a leading hub for evidence-based vision care. The AAO/CEV@US educational program provides training and mentorship in evidence synthesis methods across multiple phases. In July 2021, all Academy fellows were invited to participate in an online survey to identify pressing areas and research questions needing systematic review evidence; 879 fellows responded (Fig. 1). Those interested in the program were invited to attend a symposium at the 2022 AAO annual meeting, where they were introduced to CEV@US and the process of conducting Cochrane systematic reviews. Following the symposium, 85 fellows submitted online applications, prioritizing diverse review topics of personal interest. They also completed a 6-hour synchronous systematic review curriculum provided by CEV@US via Zoom. After a rigorous selection process, 38 fellows were accepted into the inaugural cohort in August 2022. The cohort was then organized into six writing groups, each consisting of six to seven fellows from diverse practice modes, two AAO mentors, and one CEV@US mentor. Each writing group received individualized and extensive mentorship through each phase of the writing process. Specifically, AAO mentors with clinical expertise provided guidance on developing a robust research question and interpreting results, drawing from their experience as Cochrane authors. They also advised on logistics and authorship. CEV@US methodologists played a crucial role in mentoring, offering expertise in formulating the research question, study identification, data extraction, risk-of-bias assessment, and synthesis. By August 2023, all six writing groups had published or deposited their review protocols (Table 1). By September 2024, two review manuscripts were published, four were under peer review, and all are expected to be published by the end of 2024 (Table 1).FIGURE 1: Program activities and timeline. TABLE 1 - Review topics and status Topic Status Cochrane systematic reviews Ocular surface Lubricating drops for contact lens discomfort in adults Protocol published in May 20233Review published in September 20244 Glaucoma Multifaceted behavioral interventions to improve treatment adherence of glaucoma Protocol published in May 20235Review submitted for publication in August 2024 Low vision Self-management interventions for quality of life in adults with visual impairment Protocol published in September 20236Review submitted for publication in May 2024 Pediatrics Interventions for improving adherence to amblyopia treatment in children Protocol published in August 20237Review submitted for publication in June 2024 Scoping reviews Contact lens Safety of contact lenses in correcting refractive error in the pediatric population Protocol deposited on Open Science Framework in March 20248Review published in July 20249 Traumatic brain injury Ocular motor disorders in children and adults with mild traumatic brain injury: A scoping review Protocol published in October 202310Review submitted for publication in July 2024 The six topics selected for systematic review in the AAO/CEV@US joint educational program (Table 1) address critical knowledge gaps in vision care that have significant implications for patient outcomes. Research on lubricating eye drops for contact lens discomfort in adults is critical because contact lens discomfort is a common issue that can affect adherence to lens wear and overall eye health. Dr. Barbara Caffery, the lead author of this review from Toronto Eye Care in Canada, was invited to present a Cochrane podcast.11 Given the progressive nature of glaucoma and the importance of consistent treatment to prevent vision loss, understanding the effectiveness of multifaceted behavioral interventions to improve treatment adherence in glaucoma patients is crucial. Evidence on the effectiveness of self-management interventions for enhancing the quality of life in adults with visual impairment will provide important insights for helping individuals maintain their independence and well-being despite their visual challenges. Understanding the effectiveness of interventions to improve adherence to amblyopia treatment in children is another key area, as early and effective treatment is vital for preventing long-term visual impairment. The scoping review on the safety of contact lenses for correcting refractive errors in children addresses a growing concern, as more children are using contact lenses, highlighting the importance of ensuring their safe use. Finally, the scoping review on ocular motor disorders in children and adults with mild traumatic brain injury seeks to understand better a complex and often overlooked consequence of mild traumatic brain injury, with the potential to improve diagnosis and treatment strategies. These topics not only reflect the diverse needs of the eye care community but also hold the promise of advancing patient care through evidence-based practices. Participants in the program have shared overwhelmingly positive experiences about their involvement. One participant noted, “The AAO/CEV@US program has been a great experience. I have learned so much through the coursework, live sessions, and working with my group. I have been connected with methodologists, fellow optometrists, and other vision scientists in ways I never have before because of this program.” Another participant emphasized the program's impact on their professional development: “I am so fortunate to have been given the opportunity to be part of the AAO/CEV@US program. Not only did I learn how to be more critical of research articles, but I also gained a much deeper understanding of what goes into a systematic review. This experience has been incredibly valuable as a clinician and teacher. I also value the friendships I gained with colleagues from across the country.” Additionally, a participant highlighted the program's practical benefits: “The AAO/CEV@US program has given me the opportunity to participate in a large-scale research project with like-minded people. Finding the time to do research has always been a roadblock, but the instructions were clearly laid out, and the guidance and mentorship provided have been invaluable.” These testimonials underscore the program's success in enhancing participants' research skills, fostering professional connections, and providing valuable educational experiences. The mentoring experience has proven to be equally rewarding for the mentors. One AAO mentor, an experienced Cochrane review author, highlighted the value of participating, stating, “Cochrane systematic reviews produce the highest level of evidence for guiding clinical practice, which is why I have found it important to participate in the process and why I have been excited to serve as a mentor to others who are interested in creating a review.” Another mentor, also a CEV editor, enthusiastically shared, “I have very much enjoyed being a group mentor on the innovative AAO/CEV@US Educational Program, supporting optometrists to acquire the key transferable skills needed to develop high-quality systematic reviews in priority areas for optometry.” The program fosters mutual learning, where both mentors and mentees benefit from exchanging knowledge and perspectives. Additionally, the structured timeline for delivering reviews ensures that participants stay on track and gain practical experience in a real-world setting. The AAO/CEV@US educational program has successfully engaged Academy fellows in generating high-quality evidence. From the perspective of CEV@US, partnerships with professional bodies ensure that evidence on priority research questions is available, reliable, and applied, while also fulfilling CEV@US's mission to provide high-quality education and training that equips vision professionals with the skills to interpret and conduct systematic reviews. Through its collaboration with CEV@US, the Academy strengthens its commitment to fostering intellectual curiosity and lifelong learning and facilitates the integration of rigorous scientific evidence into everyday clinical practice, ultimately improving patient outcomes. As the program continues to grow, a new cohort of 64 optometrists will begin their training and reviews in 2024, further expanding the initiative's impact and driving continued advancements in evidence-based optometry. Four reviews, with two surrounding the impact of social determinants of eye hearth, are planned for this second cohort. In addition, the new cohort will benefit from the mentorship of peers from the inaugural cohort. Through the joint AAO/CEV@US educational program, the contribution of optometry to The Cochrane Library of reviews has significantly increased, placing optometrists on the same table as other key contributors in shaping evidence-based health care.

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