Riaz Qureshi1, Augusto Azuara-Blanco2, Manuele Michelessi3, Gianni Virgili4, João Barbosa Breda5, Carlo Alberto Cutolo6, Marta Pazos7, Andreas Katsanos8, Gerhard Garhöfer9, Miriam Kolko10, Verena Prokosch-Willing11, Ali Ahmed Al Rajhi12, Flora Lum12, David Musch13, Steven Gedde14, Tianjing Li15. 1. Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland. 2. School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom. 3. IRCCS-Fondazione Bietti, Rome, Italy. 4. Department of Neurosciences, Psychology Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy. 5. Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal; and Research Group Ophthalmology, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium. 6. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences, University of Genoa and IRCCS San Martino Policlinic Hospital, Genova, Italy. 7. Department of Ophthalmology, Hospital Clínic of Barcelona, Barcelona, Spain. 8. Department of Ophthalmology, University of Ioannina, Ioannina, Greece. 9. Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria. 10. Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Glostrup, and Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark. 11. Department of Ophthalmology, Mainz University, Mainz, Germany. 12. American Academy of Ophthalmology, San Francisco, California. 13. Departments of Ophthalmology and Visual Sciences and of Epidemiology, University of Michigan, Ann Arbor, Michigan. 14. Bascom Palmer Eye Institute, Miami, Florida. 15. Department of Ophthalmology, School of Medicine, University of Colorado Denver, Aurora, Colorado. Electronic address: tianjing.li@cuanschutz.edu.
Abstract
PURPOSE: To identify systematic reviews of interventions for glaucoma conditions and to assess their reliability, thereby generating a list of potentially reliable reviews for updating glaucoma practice guidelines. DESIGN: Cross-sectional study. PARTICIPANTS: Systematic reviews of interventions for glaucoma conditions. METHODS: We used a database of systematic reviews and meta-analyses in vision research and eye care maintained by the Cochrane Eyes and Vision United States Satellite. We examined all Cochrane systematic reviews of interventions for glaucoma conditions published before August 7, 2019, and all non-Cochrane systematic reviews of interventions for glaucoma conditions published between January 1, 2014, and August 7, 2019. MAIN OUTCOME MEASURES: We assessed eligible reviews for reliability, extracted characteristics, and summarized key findings from reviews classified as reliable. RESULTS: Of the 4451 systematic reviews in eyes and vision identified, 129 met our eligibility criteria and were assessed for reliability. Of these, we classified 49 (38%) as reliable. We found open-angle glaucoma (22/49) to be the condition with the most reviews and medical management (17/49) and intraocular pressure (IOP; 43/49) to be the most common interventions and outcomes studied. Most reviews found a high degree of uncertainty in the evidence, which hinders the possibility of making strong recommendations in guidelines. These reviews found high-certainty evidence about a few topics: reducing IOP helps to prevent glaucoma and its progression, prostaglandin analogs are the most effective medical treatment for lowering IOP, laser trabeculoplasty is as effective as medical treatment as a first-line therapy in controlling IOP, the use of IOP-lowering medications in the perioperative or postoperative periods to accompany laser (e.g., trabeculoplasty) reduces the risk of postoperative IOP spikes, conventional surgery (i.e., trabeculectomy) is more effective than medications in reducing IOP, and antimetabolites and β-radiation improve IOP control after trabeculectomy. The evidence is weak regarding the effectiveness of minimally invasive glaucoma surgeries. CONCLUSIONS: Most systematic reviews evaluating interventions for glaucoma are of poor reliability. Even among those that may be considered reliable, important limitations exist in the value of information because of the uncertainty of the evidence as well as small and sometimes unimportant clinical differences between interventions.
PURPOSE: To identify systematic reviews of interventions for glaucoma conditions and to assess their reliability, thereby generating a list of potentially reliable reviews for updating glaucoma practice guidelines. DESIGN: Cross-sectional study. PARTICIPANTS: Systematic reviews of interventions for glaucoma conditions. METHODS: We used a database of systematic reviews and meta-analyses in vision research and eye care maintained by the Cochrane Eyes and Vision United States Satellite. We examined all Cochrane systematic reviews of interventions for glaucoma conditions published before August 7, 2019, and all non-Cochrane systematic reviews of interventions for glaucoma conditions published between January 1, 2014, and August 7, 2019. MAIN OUTCOME MEASURES: We assessed eligible reviews for reliability, extracted characteristics, and summarized key findings from reviews classified as reliable. RESULTS: Of the 4451 systematic reviews in eyes and vision identified, 129 met our eligibility criteria and were assessed for reliability. Of these, we classified 49 (38%) as reliable. We found open-angle glaucoma (22/49) to be the condition with the most reviews and medical management (17/49) and intraocular pressure (IOP; 43/49) to be the most common interventions and outcomes studied. Most reviews found a high degree of uncertainty in the evidence, which hinders the possibility of making strong recommendations in guidelines. These reviews found high-certainty evidence about a few topics: reducing IOP helps to prevent glaucoma and its progression, prostaglandin analogs are the most effective medical treatment for lowering IOP, laser trabeculoplasty is as effective as medical treatment as a first-line therapy in controlling IOP, the use of IOP-lowering medications in the perioperative or postoperative periods to accompany laser (e.g., trabeculoplasty) reduces the risk of postoperative IOP spikes, conventional surgery (i.e., trabeculectomy) is more effective than medications in reducing IOP, and antimetabolites and β-radiation improve IOP control after trabeculectomy. The evidence is weak regarding the effectiveness of minimally invasive glaucoma surgeries. CONCLUSIONS: Most systematic reviews evaluating interventions for glaucoma are of poor reliability. Even among those that may be considered reliable, important limitations exist in the value of information because of the uncertainty of the evidence as well as small and sometimes unimportant clinical differences between interventions.
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