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Comparative Study
. 2019 Jul 1;137(7):775-785.
doi: 10.1001/jamaophthalmol.2019.1063.

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

Ian J Saldanha  1 , Kristina B Lindsley  2 , Flora Lum  3 , Kay Dickersin  4 , Tianjing Li  4
Affiliations
Comparative Study

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

Ian J Saldanha et al. JAMA Ophthalmol. .

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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Conflict of interest statement

Conflict of Interest Disclosures: Drs Saldanha, Dickersin, and Li and Ms Lindsley reported being affiliated with Cochrane Eyes and Vision during conduct of the work related to this article. Some of the systematic reviews examined in this article were produced by Cochrane Eyes and Vision. Drs Saldanha, Dickersin, and Li and Ms Lindsley reported receiving grants from the National Eye Institute. Dr Lum reported being employed by the American Academy of Ophthalmology (AAO). This article describes systematic reviews that are underpinning the AAO Cornea/External Disease Preferred Practice Patterns being produced by the American Academy of Ophthalmology.

Figures

Figure 1.
Figure 1.. Flowchart Showing the Identification of Reliable Systematic Reviews
Systematic reviews of interventions for the management of corneal diseases were identified from the Cochrane Eyes and Vision US Satellite database of systematic reviews related to eyes and vision.
Figure 2.
Figure 2.. Assessment of 98 Systematic Reviews of Interventions for the Management of Corneal Diseases
aReasons for nonapplicability of certain systematic reviews for certain criteria are as follows: For criteria 6, 8, 9, 10, and 13, three systematic reviews did not include any studies. For criterion 7, three systematic reviews did not include any studies, and 13 systematic reviews included studies but did not assess risk of bias in included studies (thus classified as unreliable). For criterion 11, three systematic reviews did not include any studies, and 2 systematic reviews included only 1 study each. For criterion 12, three systematic reviews did not include any studies, 2 systematic reviews included only 1 study each, and 35 systematic reviews included more than 1 study but did not conduct a quantitative synthesis. bThe 5 criteria used for assessing the reliability of systematic reviews are 1, 3, 6, 12, and 15.
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References

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