Mayo-Wilson Evan, Ng Sueko Matsumura, Chuck Roy S, Li Tianjing
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, 3332 Rochambeau Avenue, Centennial, Room 306, New York, NY, 10467, USA.
BMC Ophthalmol. 2017 Sep 5;17(1):164. doi: 10.1186/s12886-017-0561-9.
Systematic reviews should inform American Academy of Ophthalmology (AAO) Preferred Practice Pattern® (PPP) guidelines. The quality of systematic reviews related to the forthcoming Preferred Practice Pattern® guideline (PPP) Refractive Errors & Refractive Surgery is unknown. We sought to identify reliable systematic reviews to assist the AAO Refractive Errors & Refractive Surgery PPP.
Systematic reviews were eligible if they evaluated the effectiveness or safety of interventions included in the 2012 PPP Refractive Errors & Refractive Surgery. To identify potentially eligible systematic reviews, we searched the Cochrane Eyes and Vision United States Satellite database of systematic reviews. Two authors identified eligible reviews and abstracted information about the characteristics and quality of the reviews independently using the Systematic Review Data Repository. We classified systematic reviews as "reliable" when they (1) defined criteria for the selection of studies, (2) conducted comprehensive literature searches for eligible studies, (3) assessed the methodological quality (risk of bias) of the included studies, (4) used appropriate methods for meta-analyses (which we assessed only when meta-analyses were reported), (5) presented conclusions that were supported by the evidence provided in the review.
We identified 124 systematic reviews related to refractive error; 39 met our eligibility criteria, of which we classified 11 to be reliable. Systematic reviews classified as unreliable did not define the criteria for selecting studies (5; 13%), did not assess methodological rigor (10; 26%), did not conduct comprehensive searches (17; 44%), or used inappropriate quantitative methods (3; 8%). The 11 reliable reviews were published between 2002 and 2016. They included 0 to 23 studies (median = 9) and analyzed 0 to 4696 participants (median = 666). Seven reliable reviews (64%) assessed surgical interventions.
Most systematic reviews of interventions for refractive error are low methodological quality. Following widely accepted guidance, such as Cochrane or Institute of Medicine standards for conducting systematic reviews, would contribute to improved patient care and inform future research.
系统评价应为美国眼科学会（AAO）的首选实践模式（PPP）指南提供依据。与即将发布的首选实践模式（PPP）屈光不正与屈光手术指南相关的系统评价质量尚不清楚。我们试图确定可靠的系统评价，以协助AAO屈光不正与屈光手术PPP。
如果系统评价评估了2012年PPP屈光不正与屈光手术中所包含干预措施的有效性或安全性，则其符合纳入标准。为了识别潜在符合条件的系统评价，我们检索了Cochrane美国眼与视觉卫星系统评价数据库。两位作者独立使用系统评价数据存储库识别符合条件的评价，并提取有关评价特征和质量的信息。当系统评价满足以下条件时，我们将其分类为“可靠”：（1）定义研究选择标准；（2）对符合条件的研究进行全面文献检索；（3）评估纳入研究的方法学质量（偏倚风险）；（4）使用适当的荟萃分析方法（仅在报告了荟萃分析时进行评估）；（5）得出的结论得到评价中提供的证据支持。
我们识别出124项与屈光不正相关的系统评价；39项符合我们的纳入标准，其中11项被分类为可靠。被分类为不可靠的系统评价未定义研究选择标准（5项；13%）、未评估方法学严谨性（10项；26%）、未进行全面检索（17项；44%）或使用了不适当的定量方法（3项；8%）。11项可靠的评价发表于2002年至2016年之间。它们纳入了0至23项研究（中位数=9），分析了0至4696名参与者（中位数=666）。7项可靠的评价（64%）评估了手术干预措施。
大多数关于屈光不正干预措施的系统评价方法学质量较低。遵循广泛认可的指南，如Cochrane或医学研究所进行系统评价的标准，将有助于改善患者护理并为未来研究提供信息。
