How evidence-based are publications in clinical ophthalmic journals?

PURPOSE: To evaluate the methodological quality and level of evidence of publications in four leading general clinical ophthalmology journals. METHODS: All 1919 articles published in the American Journal of Ophthalmology, Archives of Ophthalmology, British Journal of Ophthalmology, and Ophthalmology in 2004 were reviewed. The methodological rigor and the level of evidence in the articles were rated according to the McMaster Hedges Project criteria and the Oxford Centre for Evidence-Based Medicine levels of evidence. RESULTS: Overall, 196 (24.4%) of the 804 publications that were included for assessment met the Hedges criteria. Articles on economics evaluation and those on prognosis achieved the highest passing rate, with 80.0% and 74.4% of articles, respectively, meeting the Hedges criteria. Publications on etiology, diagnosis, and treatment fared less well, with respective passing rates of 28.3%, 20.2%, and 14.7%. Published systematic reviews and randomized controlled trials were uncommon in the ophthalmic literature, at least in these four journals during 2004. According to the Oxford criteria, 57.6% of the articles were classified as level 4 evidence compared with 18.1% classified as level 1. Articles on prognosis had the highest proportion (43.0%) rated as level 1 evidence. Generally, articles that reached the Hedges threshold were rated higher on the level-of-evidence scale (Spermans rho = 0.73; P < 0.001). CONCLUSIONS: The methodological quality of publications in the clinical ophthalmic literature was comparable to that in the literature of other specialties. There was substantial heterogeneity in quality between different types of articles. Future methodological improvements should focus on the areas identified as having the largest deficiencies.     

The reporting quality of parallel randomised controlled trials in ophthalmic surgery in 2011: a systematic review

Purpose

Randomised controlled trials (RCTs) represent a gold standard for evaluating therapeutic interventions. However, poor reporting clarity can prevent readers from assessing potential bias that can arise from a lack of methodological rigour. The Consolidated Standards of Reporting Trials statement for non-pharmacological interventions 2008 (CONSORT NPT) was developed to aid reporting. RCTs in ophthalmic surgery pose particular challenges in study design and implementation. We aim to provide the first assessment of the compliance of RCTs in ophthalmic surgery to the CONSORT NPT statement.

Method

In August 2012, the Medline database was searched for RCTs in ophthalmic surgery reported between 1 January 2011 and 31 December 2011. Results were searched by two authors and relevant papers selected. Papers were scored against the 23-item CONSORT NPT checklist and compared against surrogate markers of paper quality. The CONSORT score was also compared between different RCT designs.

Results

In all, 186 papers were retrieved. Sixty-five RCTs, involving 5803 patients, met the inclusion criteria. The mean CONSORT score was 8.9 out of 23 (39%, range 3.0–14.7, SD 2.49). The least reported items related to the title and abstract (1.6%), reporting intervention adherence (3.1%), and interpretation of results (4.7%). No significant correlation was found between CONSORT score and journal impact factor (R=0.14, P=0.29), number of authors (R=0.01, P=0.93), or whether the RCT used paired-eye, one-eye, or two-eye designs in their randomisation (P=0.97).

Conclusions

The reporting of RCTs in ophthalmic surgery is suboptimal. Further work is needed by trial groups, funding agencies, authors, and journals to improve reporting clarity.     

三种眼科学期刊引文分析

目的探讨中、美、英三国主办的三种眼科学期刊引文的引用规律及情报吸收能力。方法采用引文计量分析法统计American Journal of Ophthalmology（AJO）、British Journal of Ophthalmology（BJO）与中华眼科杂志（CJO）2005年刊载的论文所引用的参考文献,从引文数量、引文年代、普赖斯指数、自引率、高被引期刊等多方面进行比较分析。结果AJ0、BJO及CJO篇均引文数量分别为12．67、21．31及11．50,AJO、BJO及CJO的普赖斯指数分别为37．12％、33．47％及44．42％,自引率分别为13．39％、7．54％及9．89％,AJO、BJO及CJO分别引用了1140、1487及724种期刊,前13种期刊总被引频次占全部引文的58．82％、49．51％及46．39％。结论AJO、BJO及CJO各自具有不同的特点。BJO篇均引文数较高,涉猎文献范围广,自引率较低,引用文献半衰期较长;AJO引用期刊相对集中,自引率相对较高;CJO引用文献较新,普赖斯指数较高,自引率适中。     

中国大陆地区发表在SCI期刊上的眼科随机对照试验报告质量评价

背景按照循证医学（EBM）的理念对医学临床研究进行随机对照试验（RCT）能够为医疗决策提供重要证据,国际编辑组织提供的临床试验报告统一标准（CONSORT）是医学临床研究者正确撰写RCT报告的指南。目前中国临床研究人员对RCT的评价和使用方法了解的还不够。目的采用2010版CONSORT对中国大陆地区眼科研究者在SCI期刊上所发表的有关眼科疾病的RCT报告的方法学质量进行评价,为RCT报告的正确撰写提供方法学介绍。方法在PubMed平台检索中国大陆眼科研究者在SCI期刊上发表的眼科RCT研究文章,检索文献截止至2013年3月,由2位评阅者对检索的文献独立评分,统计所纳入文献对于CONSORT各项条目的符合率,根据CONSORT的发表和修订年份对文章进一步分层分析。结果共纳入60篇眼科研究相关的RCT文献,研究中的干预措施以手术类为主（34／60）,共有44篇文献设立了2个研究组,样本量的中位数为76．0。纳入的文献中,仅有22％的文章（13／60）在文题中标注了RCT。绝大多数文章在摘要和背景部分进行了合理描述,仅4篇文章提出了试验的假设,占7％。在方法部分,仅12篇文章报告了如何计算样本量,有41篇报告了资料收集的场所和地点,仅6篇文章提到了中期分析和中止原则。2010版CONSORT声明发表后,中国大陆地区所发表的RCT报告对随机化的描述并未显著改善（RR=1．06,95％CI：0．62～1．82）,对盲法进行描述的报告仅占42％（25／60）。结论中国大陆地区发表在SCI期刊上的RCT报告还存在较多问题。严格按照CONSORT声明设计并报告高质量的RCT有助于真实、客观地反映中国眼科临床研究的现状,提高中国大陆地区眼科临床试验的质量,并为眼科临床工作提供指导。     

Quality of controlled clinical trials on glaucoma and intraocular high pressure

AIM: To study the quality of controlled clinical trials on glaucoma. METHODS: Two hundred and twenty-six clinical trials published between 1980 and 1999 were selected from seven international ophthalmological journals. Their quality was assessed by four researchers with epidemiological skills using a structured questionnaire. RESULTS: Sample size was pre-estimated in 34 (15.0%) papers, which were of greater size (P = 0.05). Randomization was performed in 98.2% of the trials, although the procedure of randomization was scarcely reported. Masking was reported in 56.6% of the papers, and was more frequent in medical treatments (P < 0.001). The basal characteristics of the groups were compared in 139 papers (61.5%). Patient losses during the follow-up period were fully described in only 27 trials. Intention-to-treat analysis was used in 17 (7.7%) papers. Most trials reported P values, but a measure of effect (mean, proportion, or relative risk) appeared in only 16 trials (7.7%). Trials performed in the US more frequently compared baseline characteristics of the groups (P = 0.03), described the patient flow (P = 0.04), and used adequate statistical procedures (P = 0.03). Those trials that included a statistician or an epidemiologist among the authors were more commonly blinded (P = 0.06) and they always avoided the analyses of subgroups (P = 0.006). Several methodological issues have improved throughout the studied period. CONCLUSIONS: Several methodological characteristics should be improved when reporting a clinical trial on glaucoma. Using a checklist like that suggested by the CONSORT can help to achieve this.     

Contact lens articles in the literature.

We searched the ophthalmic literature of the past 5 years looking for patterns in the publication of contact lens articles. Contact lens articles constituted 2.59% of all ophthalmology articles. We found that a substantial percentage of the articles published in The CLAO Journal and selected optometric journals concerned contact lenses; this, however, was not the case with the major ophthalmology journals (American Journal of Ophthalmology [AJO], Ophthalmology, and Archives of Ophthalmology [Archives]). One recent contact lens development, disposable lenses, was covered by both The CLAO Journal and the major ophthalmology journals, but the coverage differed in that the orientation of the articles in the major ophthalmology journals was essentially negative. Articles about another recent development (rigid gas permeable contact lenses for extended wear), although found in The CLAO Journal, could not be found in the other ophthalmology journals. Finally, when the abstracts of all contact lens articles were reviewed, we found a negative slant to articles published in AJO and Archives. We believe that the major ophthalmology journals present a rather negative view of contact lenses; this, we think, impedes unbiased dissemination of information about new contact lens developments.     

Sample size in studies on diagnostic accuracy in ophthalmology: a literature survey

AIM: To assess the sample sizes used in studies on diagnostic accuracy in ophthalmology. Design and sources: A survey literature published in 2005. METHODS: The frequency of reporting calculations of sample sizes and the samples' sizes were extracted from the published literature. A manual search of five leading clinical journals in ophthalmology with the highest impact (Investigative Ophthalmology and Visual Science, Ophthalmology, Archives of Ophthalmology, American Journal of Ophthalmology and British Journal of Ophthalmology) was conducted by two independent investigators. RESULTS: A total of 1698 articles were identified, of which 40 studies were on diagnostic accuracy. One study reported that sample size was calculated before initiating the study. Another study reported consideration of sample size without calculation. The mean (SD) sample size of all diagnostic studies was 172.6 (218.9). The median prevalence of the target condition was 50.5%. CONCLUSION: Only a few studies consider sample size in their methods. Inadequate sample sizes in diagnostic accuracy studies may result in misleading estimates of test accuracy. An improvement over the current standards on the design and reporting of diagnostic studies is warranted.     

中华眼科杂志1999至2004年载文被引分析研究

目的从文献引证的角度透视中华眼科杂志的学术水平和期刊质量。方法依据《中国生物医学期刊引文数据库》（CMCI）提供的资料和数据,采用文献计量学方法,对中华眼科杂志载文被CMCI来源期刊引用的情况进行统计分析及评价。结果单篇平均被引次数为4．17次,被引频次较高的论文数占载文量的多数。被引作者群分布在我国的32个省、直辖市、自治区,其中北京、广东、上海居前列。有354种期刊引用中华眼科杂志,被引率49．96％,自引率8．87％。结论中华眼科杂志所载论文质量和被引率均较高,已形成具有独立风格和特色且相对稳定的研究体系。该刊不仅是我国眼科学研究领域最重要的信息源之一,也是我国医学领域的主要核心期刊。     

七种眼科文献中统计方法的应用现状分析

目的 探讨眼科杂志中常用统计方法的类型、使用频率和常见统计缺陷。方法 阅读2000年《中华眼科杂志》、《中华眼底病杂志》、《眼科研究》、《中国实用眼科杂志》、《眼科新进展》、《临床眼科杂志》和《眼科》7种杂志中所有论著及实验研究论文，计算各种统计方法出现的类型、使用频率和统计缺陷类型。结果 7种杂志共发表论著973篇，使用统计方法的文献513篇（52．72％），未使用统计方法的文献460篇（47．28％）。共涉及统计方法14种，主要为t检验（43．37％）、卡方检验（23．78％）、方差分析（15．59％）和直线相关与回归（8．97％）等。在513篇有统计文献中，出现各种统计缺陷290篇（56．53％），常见统计缺陷有仅注明统计方法而不标出统计量（56．90％）、不注明使用何种统计方法（36．55％）和统计方法使用不当（6．55％）等。结论 眼科医师应正确使用常用的统计方法，尽量避免统计错误，以提高文献的学术价值。     

2005年五种眼科期刊基金资助论文统计分析

目的研究我国5种中文眼科期刊基金资助论文情况,揭示目前眼科领域的基金资助论文特点及科研状况。方法选择2005年出版的中华眼科杂志、眼外伤职业眼病杂志、眼科研究、中国实用眼科杂志、中华眼底病杂志共5种国内公开发行的眼科期刊,采用引文计量分析方法对基金资助论文数量、基金资助论文率、基金资助论文的地区分布及研究方向、基金资助论文的作者合作度、基金资助论文获基金资助项目数量及其在栏目中的分布等进行分析探讨。结果2005年5种眼科期刊所载基金资助论文率为12．72％（222／1745）,其中国家级为4．70％,省部级为4．81％,其他基金为3．21％。基金资助论文作者合作度最高为5．21,基金资助论文产出量以广东省最高,占31．98％（71／222）。各期刊基金资助论文均以获单项基金资助为主,为149项（67．12％）。基金资助论文研究主要集中于视网膜（51／222,22．97％）、角膜（38／222,17．12％）及晶状体领域（25／222,11．26％）。结论5种眼科期刊发表基金资助论文数量、级别均较往年有所提高,但与其他专业领域相比还有一定差距,尚待提高。     

Compliance with methodological standards when evaluating ophthalmic diagnostic tests.

PURPOSE: To draw attention to the importance of methodological standards when carrying out evaluations of ophthalmic diagnostic tests by reviewing the extent of compliance with these standards in reports of evaluations published within the ophthalmic literature. METHODS: Twenty published evaluations of ophthalmic screening/diagnostic tests or technologies were independently assessed by two reviewers for compliance with the following methodological standards: specification of the spectrum composition for populations used in the evaluation, analysis of pertinent subgroups, avoidance of work-up (verification) bias, avoidance of review bias, presentation of precision of results for test accuracy, presentation of indeterminate test results, and presentation of test reproducibility. RESULTS: Compliance ranged from just 10% (95%CI, 1%-32%) for presentation of test reproducibility data and avoidance of review bias to 70% (95%CI, 46%-88%) for avoidance of work-up bias and presentation of indeterminate test results. Only 5 of the 20 evaluations complied with four or more of the methodological standards and none with more than five of the standards. CONCLUSIONS: The evaluations of ophthalmic diagnostic tests discussed in this article show limited compliance with accepted methodological standards but are no worse than previously described for evaluations published in general medical journals. Adherence to these standards by researchers can improve the study design and reporting of evaluations of new diagnostic techniques. Limited compliance, combined with a lack of awareness of the standards among users of research evidence, may lead to the inappropriate adoption of new diagnostic technologies, with a consequent waste of health care resources.     

我国眼科学科技核心期刊2010-2014年主要学术指标对比研究

目的 探究我国眼科学科技核心期刊2010-2014年学术影响力的发展趋势。设计 回顾性资料分析。研究对象 我国眼科学科技核心期刊。方法 以2011-2015年中国科技引证报告（核心版）收录的眼科学科技核心期刊的主要学术指标为来源数据,比较我国眼科学科技核心期刊的总被引频次、影响因子、他引率、基金论文比和综合评价总分等指标。主要指标 期刊总被引频次、影响因子、他引率、基金论文比、综合评价总分。结果 2010-2014年,《中华眼科杂志》历年总被引频次均位居所有中国眼科学科技核心期刊首位,分别为2318、2584、2717、2616、2278;《国际眼科杂志》发文总量12 336篇位居第二位,近年来各项指标提升快;5年影响因子平均值位居前5位的分别是《中华眼科杂志》、《中华眼底病杂志》、《眼科新进展》、《中国斜视与小儿眼科杂志》、《眼科》,且其综合评价总分也相对较高,平均值分别为79.58、41.28、45.20、26.24、38.88。结论 我国眼科学科技核心期刊主要学术指标差异明显,但各自仍有上升空间。（眼科, 2016, 25： 413－417）     

中华眼科杂志2001至2004年引文分析

目的研究中华眼科杂志文献引用规律及我国眼科学研究领域科研人员的文献利用与需求特征。方法采用引文计量分析法,统计中华眼科杂志2001至2004年间刊载的926篇论文所引用的参考文献(引文)。结果926篇论文中,有引文的论文共850篇,引文率为91．79％,篇均引文8．05条;引文中期刊912种(91．97％),图书266种(7．85％);普赖斯指数35．50％;期刊自引626条,自引率8．40％。被引用频次居前17位的中、外文期刊的引文量占总引用期刊引文量的54．03％。结论中华眼科杂志涉猎文献范围广,引文类型以期刊为主,语种以英文文献为多,引文的外文语种结构较为单一,研究引用文献比较滞后,文献半衰期较长,专业人员利用近5年内新文献的能力有待于进一步提高。     

中西医结合治疗外伤性视神经病变疗效评价的Meta分析

目的:系统评价中西医结合治疗外伤性视神经病变(TON)的临床疗效及安全性。方法:通过计算机检索PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、维普数据库自建库至2020-05的关于中西医结合与单纯西医治疗TON的随机对照研究,使用Cochrane评价手册对纳入文献进行质量评价,使用RevMan5.3统计软件进行资料提取与Meta分析。结果:共筛选出12篇符合纳入、排除标准的文献;Meta分析结果显示,与单纯西药治疗TON比较,中西医结合治疗有效率更高[RR=1.33,95%CI(1.23~1.45),P<0.001];在改善视力[MD=0.18,95%CI(0.14~0.23),P<0.001]、视野平均缺损[MD=-3.08,95%CI(-5.20~0.96),P=0.004]、视觉诱发电位P100波峰潜时[MD=-9.47,95%CI(-16.37~2.57),P=0.007]以及视觉诱发电位P100波峰振幅[MD=1.44,95%CI(0.22~2.66),P=0.02]上作用更显著。纳入文献有2篇提及不良反应的发生和处理,余10篇均未描述。结论:与单纯西医治疗相比,中西医结合治疗TON的疗效更佳。     

Acupuncture for treating dry eye: a systematic review

Purpose: The objective of this review was to assess the effectiveness of acupuncture as a treatment option for treating the condition of dry eye. Methods: We searched the literature using 14 databases from their inceptions to 3 December 2009, without language restrictions. We included randomized clinical trials (RCTs) comparing acupuncture with conventional treatment. Their risk of bias was assessed using Cochrane criteria. Results: Six RCTs met all the inclusion criteria. Three RCTs compared the effects of acupuncture with artificial tears in patients with xerophthalmia or Sjögren syndrome. A meta‐analysis of these data showed that acupuncture improved tear break‐up times (p < 0.0001), Schirmer test scores (p < 0.00001), response rates (p = 0.002) and the region of cornea fluorescent staining (p = 0.0001) significantly more than artificial tears did. The other three RCTs compared the effects of acupuncture plus artificial tears with artificial tears alone. Two of these studies failed to show significant effects of acupuncture, while one reported significant effects. For Schirmer test scores and frequency of artificial tear usage, two RCTs reported superior effects of acupuncture plus artificial tears, while one RCT failed to do so. Conclusion: These results provide limited evidence for the effectiveness of acupuncture for treating dry eye. However, the total number of RCTs, the total sample size and the methodological quality were too low to draw firm conclusions.