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Original Investigation
May 9, 2019

Reliability of the Evidence Addressing Treatment of Corneal Diseases: A Summary of Systematic Reviews

Author Affiliations
  • 1Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
  • 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
  • 3American Academy of Ophthalmology, San Francisco, California
  • 4Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA Ophthalmol. 2019;137(7):775-785. doi:10.1001/jamaophthalmol.2019.1063
Key Points

Question  What is the reliability of the existing systematic reviews addressing interventions for corneal diseases?

Findings  This study identified 98 systematic reviews (33 classified as unreliable and 65 as reliable) addressing 15 corneal diseases. The most frequent reasons for unreliability were that searches were not comprehensive, risk of bias was not assessed, and, when a quantitative synthesis was conducted, inappropriate methods were used.

Meaning  Adherence to well-established best practices regarding systematic review conduct might help make future systematic reviews in eyes and vision more reliable.

Abstract

Importance  Patient care should be informed by clinical practice guidelines, which in turn should be informed by evidence from reliable systematic reviews. The American Academy of Ophthalmology is updating its Preferred Practice Patterns (PPPs) for the management of the following 6 corneal diseases: bacterial keratitis, blepharitis, conjunctivitis, corneal ectasia, corneal edema and opacification, and dry eye syndrome.

Objective  To summarize the reliability of the existing systematic reviews addressing interventions for corneal diseases.

Data Source  The Cochrane Eyes and Vision US Satellite database.

Study Selection  In this study of published systematic reviews from 1997 to 2017 (median, 2014), the Cochrane Eyes and Vision US Satellite database was searched for systematic reviews evaluating interventions for the management of any corneal disease, combining eyes and vision keywords and controlled vocabulary terms with a validated search filter.

Data Extraction and Synthesis  The study classified systematic reviews as reliable when each of the following 5 criteria were met: the systematic review specified eligibility criteria for inclusion of studies, conducted a comprehensive literature search for studies, assessed risk of bias of the individual included studies, used appropriate methods for quantitative syntheses (meta-analysis) (only assessed if meta-analysis was performed), and had conclusions that were supported by the results of the systematic review. They were classified as unreliable if at least 1 criterion was not met.

Main Outcomes and Measures  The proportion of systematic reviews that were reliable and the reasons for unreliability.

Results  This study identified 98 systematic reviews that addressed interventions for 15 corneal diseases. Thirty-three of 98 systematic reviews (34%) were classified as unreliable. The most frequent reasons for unreliability were that the systematic review did not conduct a comprehensive literature search for studies (22 of 33 [67%]), did not assess risk of bias of the individual included studies (13 of 33 [39%]), and did not use appropriate methods for quantitative syntheses (meta-analysis) (12 of 17 systematic reviews that conducted a quantitative synthesis [71%]). Sixty-five of 98 systematic reviews (66%) were classified as reliable. Forty-two of the 65 reliable systematic reviews (65%) addressed corneal diseases relevant to the 2018 American Academy of Ophthalmology PPPs; 33 of these 42 systematic reviews (79%) are cited in the 2018 PPPs.

Conclusions and Relevance  One in 3 systematic reviews addressing interventions for corneal diseases are unreliable and thus were not used to inform PPP recommendations. Careful adherence by systematic reviewers and journal editors to well-established best practices regarding systematic review conduct and reporting might help make future systematic reviews in eyes and vision more reliable.

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