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Review
September 2018

Appraising the Quality of Systematic Reviews for Age-Related Macular Degeneration Interventions: A Systematic Review

Author Affiliations
  • 1Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
  • 2School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
JAMA Ophthalmol. 2018;136(9):1051-1061. doi:10.1001/jamaophthalmol.2018.2620
Key Points

Question  What is the methodological quality of systematic reviews on age-related macular degeneration interventions?

Findings  In this systematic review, review quantity is found to be increasing, but many age-related macular degeneration intervention reviews have major methodological limitations, and quality may not be improving over time. In particular, poor adherence to referring to an a priori design and reporting conflicts of interest was noted.

Meaning  Clinicians need to be aware of potential methodological deficiencies between systematic reviews in the field of age-related macular degeneration; areas for improvement in the conduct and reporting of systematic reviews, which may have a positive impact on accurate dissemination of knowledge on age-related macular degeneration, are recommended in this analysis.

Abstract

Importance  Age-related macular degeneration (AMD) is a leading cause of vision impairment. It is imperative that AMD care is timely, appropriate, and evidence-based. It is thus essential that AMD systematic reviews are robust; however, little is known about the quality of this literature.

Objectives  To investigate the methodological quality of systematic reviews of AMD intervention studies, and to evaluate their use for guiding evidence-based care.

Evidence Review  This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All studies that self-identified as a systematic review in their title or abstract or were categorized as a systematic review from a medical subject heading and investigated the safety, efficacy and/or effectiveness of an AMD intervention were included. Comprehensive electronic searches were performed in Ovid MEDLINE, Embase, and the Cochrane Library from inception to March 2017. Two reviewers independently assessed titles and abstracts, then full-texts for eligibility. Quality was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool. Study characteristics (publication year, type of intervention, journal, citation rate, and funding source) were extracted.

Findings  Of 983 citations retrieved, 71 studies (7.6%) were deemed eligible. The first systematic review relating to an AMD intervention was published in 2003. More than half were published since 2014. Methodological quality was highly variable. The mean (SD) AMSTAR score was 5.8 (3.2) of 11.0, with no significant improvement over time (r = −0.03; 95% CI, −0.26 to 0.21; P = .83). Cochrane systematic reviews were overall of higher quality than reviews in other journals (mean [SD] AMSTAR score, 9.9 [1.2], n = 15 vs 4.7 [2.2], n = 56; P < .001). Overall, there was poor adherence to referring to an a priori design (22 articles [31%]) and reporting conflicts of interest in both the review and included studies (16 articles [23%]). Reviews funded by government grants and/or institutions were generally of higher quality than industry-sponsored reviews or where the funding source was not reported.

Conclusions and Relevance  There are gaps in the conduct of systematic reviews in the field of AMD. Enhanced endorsement of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement by refereed journals may improve review quality and improve the dissemination of reliable evidence relating to AMD interventions to clinicians.

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