Adherence of glaucoma intervention studies to World Glaucoma Association guidelines.
Servillo Andrea, Cutolo Carlo Alberto, Viganò Chiara, Forte Paolo, Manocchio Riccardo, Gazzard Gus, Rossetti Luca, Iester Michele, Oddone Francesco, Virgili Gianni
AI Summary
Glaucoma surgical/laser studies show poor adherence (47%) to WGA reporting guidelines, especially for success definitions. This highlights a critical need for updated guidelines and improved reporting to standardize clinical evidence.
Abstract
Objective
To assess the adherence of glaucoma surgical and laser studies to WGA guidelines for reporting glaucoma surgery studies, analyse trends in adherence over time and explore associations between adherence and study characteristics.
Methods
Systematic review (PROSPERO:CRD42023394477) of glaucoma surgical and laser studies published between 2010 and 2023 in PubMed/MEDLINE and EMBASE. Eligible studies included RCTs, non-randomized comparative and prospective observational designs (>100 eyes). Two reviewers independently extracted data across five domains: Methodology, Definition of success, Ethics, Postoperative complications and Statistical reporting. Temporal trends and associations with study features were analysed using linear regression.
Results
Two hundred and fifty-six studies were included, 75% of which were published in Q1-Q3 journals. Mean overall adherence was 47% ± 9.2%. Domain-level adherence was highest in Ethics (61% ± 20%), followed by Postoperative complications (50% ± 22%), Statistical reporting (48% ± 18%), Methodology (44% ± 12%) and Definition of success (30% ± 13%). No significant differences (p > 0.06) were observed in overall adherence for studies from Europe, Asia, Oceania or the Middle East. Studies involving cataract surgery for angle-closure disease (est. = -10% [-19%, -2.2%], p = 0.014) and laser trabeculoplasty (est. = -7.1% [-11%, -3.5%], p < 0.001) had lower adherence compared with trabeculectomy, while MIGS studies showed no difference (p = 0.45). Visual field progression was reported in only 3% of studies, while various anatomical outcomes (e.g. bleb morphology) were reported in 0%-24% of studies.
Conclusion
Current literature shows poor adherence to WGA guidelines across both traditional and newer glaucoma surgeries, reflecting inadequate reporting and outdated recommendations. Evidence-based updates, broader consensus and stronger implementation are needed to ensure standardized and meaningful reporting.
Key Concepts6
Current literature on glaucoma surgical and laser studies shows poor adherence to World Glaucoma Association (WGA) guidelines, reflecting inadequate reporting and outdated recommendations.
The mean overall adherence to World Glaucoma Association (WGA) guidelines for glaucoma surgical and laser studies published between 2010 and 2023 was 47% ± 9.2% in a systematic review of 256 studies.
Adherence to World Glaucoma Association (WGA) guidelines in glaucoma surgical and laser studies was highest in the Ethics domain (61% ± 20%) and lowest in the Definition of success domain (30% ± 13%) in a systematic review of 256 studies.
Studies involving cataract surgery for angle-closure disease had lower adherence to World Glaucoma Association (WGA) guidelines (est. = -10% [-19%, -2.2%], p = 0.014) compared with trabeculectomy studies in a systematic review of 256 studies.
Studies on laser trabeculoplasty had lower adherence to World Glaucoma Association (WGA) guidelines (est. = -7.1% [-11%, -3.5%], p < 0.001) compared with trabeculectomy studies in a systematic review of 256 studies.
Visual field progression was reported in only 3% of glaucoma surgical and laser studies, while various anatomical outcomes (e.g., bleb morphology) were reported in 0%-24% of studies in a systematic review of 256 studies.
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