Abukhaled Yara, Allawama Tharaa M, Abu Serhan Hashem
University of Tennessee Health and Science Center, Tennessee, USA.
School of Medicine, The University of Jordan, Amman, Jordan.
Med Hypothesis Discov Innov Ophthalmol. 2025 Jul 31;14(2):40-49. doi: 10.51329/mehdiophthal1522. eCollection 2025 Summer.
Systematic reviews and meta-analyses (SRMAs) are central to evidence-based ophthalmology, influencing clinical guidelines and treatment decisions. However, the rapid increase in SRMA publications has exposed serious ethical concerns, including selective reporting, duplicate publication, plagiarism, authorship misconduct, and undeclared conflicts of interest. Despite established frameworks such as Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), International Prospective Register of Systematic Reviews (PROSPERO), and International Committee of Medical Journal Editors (ICMJE), ethical compliance remains inconsistent, undermining the credibility of synthesized evidence. We aimed to examine the ethical landscape of SRMAs with a particular focus on ophthalmology, highlighting common pitfalls, evaluating current guidelines, and providing practical recommendations to ensure that these reviews are conducted and reported with the highest ethical standards-ultimately safeguarding the integrity of the evidence base that underpins clinical eye care.
A structured literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar through May 2025 using combinations of the terms "systematic review," "meta-analysis," "ethics," "research integrity," and "ophthalmology." Relevant guidelines, peer-reviewed studies, and editorials were synthesized to identify ethical pitfalls and propose best practice solutions.
We illustrate these challenges with ophthalmology-specific examples and highlight the downstream impact of unethical SRMAs on clinical practice and public trust. We also propose actionable recommendations for researchers, editors, and institutions to enhance the ethical quality of SRMAs, including improved training in research integrity, stricter enforcement of reporting guidelines, and increased editorial oversight. By addressing these ethical dimensions, the ophthalmic community can ensure that SRMAs not only meet methodological benchmarks but also reflect the core values of scientific honesty, accountability, and patient-centeredness. Approximately one-third of ophthalmology SRMAs fail to assess bias or comply with PRISMA guidelines. Industry-sponsored reviews have shown a tendency to favor commercially linked interventions, raising objectivity concerns. Key ethical concerns include: lack of protocol registration, selective inclusion of studies, inclusion of retracted or flawed trials, duplicate or plagiarized data, and authorship and disclosure misconduct.
To protect the integrity of ophthalmic evidence synthesis, SRMAs must adhere to the highest ethical standards. Researchers should commit to transparent, methodologically rigorous, and ethically sound practices. Journals and institutions must enforce compliance, provide oversight, and support education in research integrity. Field-specific adaptations of reporting standards may further support ethical clarity. Ultimately, ethical SRMAs are critical to preserving trust, guiding responsible care, and fulfill their intended role as trustworthy instruments in advancing evidence-based ophthalmology.
系统评价和荟萃分析（SRMAs）是循证眼科学的核心，影响着临床指南和治疗决策。然而，SRMA出版物的迅速增加暴露了严重的伦理问题，包括选择性报告、重复发表、抄袭、作者不当行为以及未申报的利益冲突。尽管有诸如系统评价和荟萃分析的首选报告项目（PRISMA）、国际系统评价前瞻性注册库（PROSPERO）以及国际医学期刊编辑委员会（ICMJE）等既定框架，但伦理合规情况仍然参差不齐，损害了综合证据的可信度。我们旨在审视SRMAs的伦理状况，特别关注眼科领域，突出常见陷阱，评估现行指南，并提供实用建议，以确保这些评价以最高的伦理标准进行和报告，最终维护支撑临床眼科护理的证据基础的完整性。
截至2025年5月，在PubMed、Scopus、科学网和谷歌学术中进行结构化文献检索，使用“系统评价”“荟萃分析”“伦理”“研究诚信”和“眼科”等术语的组合。综合相关指南、同行评议研究和社论，以识别伦理陷阱并提出最佳实践解决方案。
我们用眼科领域的具体例子阐述了这些挑战，并强调了不道德的SRMAs对临床实践和公众信任的下游影响。我们还为研究人员、编辑和机构提出了可行的建议，以提高SRMAs的伦理质量，包括加强研究诚信培训、更严格地执行报告指南以及加强编辑监督。通过解决这些伦理问题，眼科界可以确保SRMAs不仅符合方法学标准，而且反映科学诚信、问责制和以患者为中心的核心价值观。大约三分之一的眼科SRMAs未能评估偏倚或遵守PRISMA指南。行业资助的评价显示出倾向于支持与商业相关的干预措施，引发了对客观性的担忧。关键的伦理问题包括：缺乏方案注册、选择性纳入研究、纳入撤回或有缺陷的试验、重复或抄袭数据以及作者身份和披露不当行为。
为保护眼科证据综合的完整性，SRMAs必须坚持最高的伦理标准。研究人员应致力于透明、方法严谨且符合伦理的实践。期刊和机构必须强制合规、提供监督并支持研究诚信教育。针对特定领域的报告标准调整可能进一步有助于伦理清晰。最终，符合伦理的SRMAs对于维护信任、指导负责任的护理以及在推进循证眼科学中发挥其作为可靠工具的预期作用至关重要。
