A large percentage of the authors of American Academy of Ophthalmology clinical practice guidelines published between 2016 and 2020 failed to disclose their relevant financial interests accurately or at all. Photo: Getty Images. Click image to enlarge.

Since the Physician Payments Sunshine Provision of the Affordable Care Act in 2013, medical supply manufacturers (i.e., industry) must report specific payments to physicians and medical teaching institutions. To ensure transparency, the information is centralized on the public US Centers for Medicare and Medicaid Open Payments database. A research team recently assessed payments reported by authors of the American Academy of Ophthalmology (AAOph) Practice Pattern Guidelines compared with payments reported by industry to have been given to these authors to evaluate the disclosures’ accuracy and authors’ compliance to the Council of Medical Specialty Societies’ Code for Interactions with Companies. Industry reported physician guideline authors to have received significant industry payments, some of which were not disclosed within information of the guidelines.¹

The cross-sectional study, published in JAMA Ophthalmology, reviewed in May 2022 all clinical guidelines in the AAOph Preferred Practice Patterns since 2013, the first year with publicly available industry payment reports. A total of 24 AAOph guidelines released between 2016 and 2020 were included. The observed cohort consisted of 188 physician author names, including 83 names assigned as women (44.1%) and 105 names assigned as men (55.9%). Authors could be counted multiple times in these 188 names.

According to AAOph guidelines, 149 authors (79.3%) had no financial disclosures while serving on the guideline committee. Among these 149 authors, 81 authors (54.4%) had payments reported by industry on the Open Payments database not disclosed within the guideline reports.  The payments reported by industry to have been received by physician authors of AAOph guidelines were substantial, with a median of $691.17 and a mean of $29,849.35, which is higher compared with industry payments received by clinical guideline physician authors in other medical specialties.¹

“Moving forward, AAOph policies could be modified by reinforcing authors’ reviews of their disclosures with disclosures reported by industry on the Open Payments database,” the researchers concluded. “Increasing authors’ awareness and understanding of the AAOph policy statement may also contribute to better declaration of conflicts of interest in clinical guidelines. It remains unclear if reporting them alone is sufficient to mitigate industry influence on evidence-based guidelines.”¹

A commentary also published in JAMA Ophthalmology agreed with the authors of the main study that “practice guidelines can directly impact patient care, making the importance of transparency on the part of guideline authors all the more critical.”²

However, she noted that “one must infer that when a guideline author is listed as having no financial relationships to disclose, a determination was made that none of the guideline author’s financial interests was relevant to the subject matter of the guideline.”

“It is unknown whether some guideline authors failed to disclose any direct financial relationships with companies, even if they received payments as reported in the Open Payments website, whether the relationships that were disclosed to the AAOph were determined not to relate to the content of the guideline or whether the relationships were judged de minimus and therefore not relevant,” she added.

The commentary also drew attention to the fact that many individuals authored up to eight different guidelines during the study period, and the 188 physician guideline authors represented instances of authorship rather than individuals. Thus, the findings pertain to fewer individuals (n = 66) than might be readily apparent. The author also proposed that the study may have underestimated the prevalence of potential conflicts of interest because the authors only reviewed financial interests reported in Open Payments during the time period a particular guideline was developed.

“While it is not clear to what extent the study reveals there were failures to disclose in AAOph clinical practice guidelines, its recommendations for ongoing education of guideline authors, as well as oversight and monitoring of disclosures by specialty societies, are valuable,” the commentary concluded.²