Gaming disorder has been described as an urgent public health problem and has garnered many systematic reviews of its associations with other health conditions. However, review methodology can contribute to bias in the conclusions, leading to research, policy, and patient care that are not truly evidence-based. This study followed a pre-registered protocol (PROSPERO 2018 CRD42018090651) with the objective of identifying reliable and methodologically-rigorous systematic reviews that examine the associations between gaming disorder and depression or anxiety in any population. We searched PubMed and PsycInfo for published systematic reviews and the gray literature for unpublished systematic reviews as of June 24, 2020. Reviews were classified as reliable according to several quality criteria, such as whether they conducted a risk of bias assessment of studies and whether they clearly described how outcomes from each study were selected. We assessed possible selective outcome reporting among the reviews. Seven reviews that included a total of 196 studies met inclusion criteria. The overall number of participants was not calculable because not all reviews reported these data. All reviews specified eligibility criteria for studies, but not for outcomes within studies. Only one review assessed risk of bias. Evidence of selective outcome reporting was found in all reviews-only one review incorporated any of the null findings from studies it included. Thus, none were classified as reliable according to prespecified quality criteria. Systematic reviews related to gaming disorder do not meet methodological standards. As clinical and policy decisions are heavily reliant on reliable, accurate, and unbiased evidence synthesis; researchers, clinicians, and policymakers should consider the implications of selective outcome reporting. Limitations of the current summary include using counts of associations and restricting to systematic reviews published in English. Systematic reviewers should follow established guidelines for review conduct and transparent reporting to ensure evidence about technology use disorders is reliable.
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... Anxiety is one of the most common mental health disorders treated in primary care (13), with an annual incidence of 1-4% and a lifetime prevalence of 4-7% (14,15). Symptoms of anxiety have been found to be significantly higher in individuals with IGD (16), and research has revealed a significant correlation between IGD and anxiety (17). Another study found IGD and anxiety to be comorbid (18). ...
... Few studies have investigated IGD in both children and adolescents simultaneously (26)(27)(28), and sample sizes have been modest. To sample a sufficient number of positive IGD patients through screening the general population requires large-scale investigation (17). As such, a large-scale survey and evaluation of the prevalence of IGD in children and adolescents are needed to explore the impact of anxiety on IGD. ...
Internet gaming disorder (IGD) has become a serious public health problem in East Asia, and studies have reported IGD to be significantly associated with anxiety, but no causal relationship between the two has yet been demonstrated. Children are at high risk of developing IGD, however, previous studies have principally focused on the condition in adults and adolescents and reported non-clinical samples. A large-scale survey is needed to research and evaluate IGD and anxiety in children and adolescents to understand the current situation of IGD in children and explore the impact of IGD on anxiety.
A cross-sectional study using an online questionnaire was conducted between March 1 and July 31, 2021. A total of 10,479 school children and adolescents in the western provinces of China were selected by convenience sampling. A questionnaire was used to collect data anonymously. The questionnaire covered IGD and the Revised Children's Manifest Anxiety Scale (RCMAS). Welch's ANOVA Test and Games-Howell test were used to test for differences in anxiety levels between IGD groups. Poisson regression analysis was used to further investigate the key predictors of IGD.
3.2% of participants ( n = 334) (95% CI: 2.9–3.2%) were classified as at high risk of presenting with IGD, 71.1% ( n = 7,454) (95% CI: 70.3–72.0%) were classified as low-risk players, and 25.7% ( n = 2,691) (95% CI: 24.9–26.5%) were classified as non-gaming. The average RCMAS score was (7.18 ± 7.534). The high-risk group had a higher total score RCMAS, as well as scoring higher in its three dimensions. Regression analysis using gender, age, and total RCMAS score as independent variables, and risk of IGD as a dependent variable showed that the odds ratio (OR) for gender was 2.864 (95% CI: 2.267–3.618), and the OR for total RCMAS score was 1.101 (95% CI: 1.087–1.114). The OR for age was not statistically significant.
Anxiety was a predictor of IGD, with statistically significant group differences in total anxiety, as well as the dimensions of physiological anxiety, social correlation, and sensitivity. The timely assessment of anxiety in children and adolescents, training social skills, and facilitating effective integration into society could be effective ways of reducing the incidence and impact of IGD.
... Furthermore, the moderate positive correlations between ACSID-11 scores and the PHQ-4 measuring symptoms of depression and anxiety supports the criterion validity of the new assessment tool. The results are consistent with previous findings on associations between (comorbid) mental problems and specific Internet-use disorders including gaming disorder (Mihara & Higuchi, 2017;but see;Colder Carras, Shi, Hard, & Saldanha, 2020), pornography-use disorder (Duffy, Dawson, & Das Nair, 2016), buying-shopping disorder (Kyrios et al., 2018), social-networks-use disorder (Andreassen, 2015), and gambling disorder (Dowling et al., 2015). Also, the ACSID-11 (especially online gambling disorder and social-networksuse disorder) was inversely correlated with the measure of life satisfaction. ...
Background and aims
With the inclusion of gaming disorder in the ICD-11, diagnostic criteria were introduced for this relatively new disorder. These criteria may also be applied to other potential specific Internet-use disorders, which may be classified in ICD-11 as other disorders due to addictive behaviors, such as online buying-shopping disorder, online pornography-use disorder, social-networks-use disorder, and online gambling disorder. Due to the heterogeneity in existing instruments, we aimed to develop a consistent and economic measure of major types of (potential) specific Internet-use disorders based on ICD-11 criteria for gaming disorder.
The new 11-item Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) measures five behavioral addictions with the same set of items by following the principles of WHO’s ASSIST. The ACSID-11 was administered to active Internet users ( N = 985) together with an adaptation of the Ten-Item Internet Gaming Disorder Test (IGDT-10) and screeners for mental health. We used Confirmatory Factor Analyses to analyze the factor structure of ACSID-11.
The assumed four-factorial structure was confirmed and was superior to the unidimensional solution. This applied to gaming disorder and to the other specific Internet-use disorders. ACSID-11 scores correlated with IGDT-10 as well as with the measures of psychological distress.
Discussion and Conclusions
The ACSID-11 seems to be suitable for the consistent assessment of (potential) specific Internet-use disorders based on ICD-11 diagnostic criteria for gaming disorder. The ACSID-11 may be a useful and economic instrument for studying various behavioral addictions with the same items and improving comparability.
... If play is not properly framed, it can also create unintended conflicts-especially if it challenges dominant social norms or moral rules (233,234). Among the risks of digital media and play that have been identified are stigmatization through social media (235), cyberbullying in massive multiplayer online games (236), and compulsive behavior in Internet gaming disorders (236)(237)(238). The challenge in implementing a playground for health research then is developing a mode of interaction that is flexible enough to maximize inclusive participation and leaves room for potential conflicts that arise from divergent views, but provides a frame in which the limits of play are explained and maintained through a shared commitment to creating a safe space for exchange (239). ...
The value of understanding patients' illness experience and social contexts for advancing medicine and clinical care is widely acknowledged. However, methodologies for rigorous and inclusive data gathering and integrative analysis of biomedical, cultural, and social factors are limited. In this paper, we propose a digital strategy for large-scale qualitative health research, using play (as a state of being, a communication mode or context, and a set of imaginative, expressive, and game-like activities) as a research method for recursive learning and action planning. Our proposal builds on Gregory Bateson's cybernetic approach to knowledge production. Using chronic pain as an example, we show how pragmatic, structural and cultural constraints that define the relationship of patients to the healthcare system can give rise to conflicted messaging that impedes inclusive health research. We then review existing literature to illustrate how different types of play including games, chatbots, virtual worlds, and creative art making can contribute to research in chronic pain. Inspired by Frederick Steier's application of Bateson's theory to designing a science museum, we propose DiSPORA (Digital Strategy for Play-Oriented Research and Action), a virtual citizen science laboratory which provides a framework for delivering health information, tools for play-based experimentation, and data collection capacity, but is flexible in allowing participants to choose the mode and the extent of their interaction. Combined with other data management platforms used in epidemiological studies of neuropsychiatric illness, DiSPORA offers a tool for large-scale qualitative research, digital phenotyping, and advancing personalized medicine.
This book constitutes the refereed post-conference proceedings of the International Conference on Context-Aware Systems and Applications, held in October 2021. Due to COVID-19 pandemic the conference was held virtually.
The 25 revised full papers presented were carefully selected from 52 submissions. The papers cover a wide spectrum of modern approaches and techniques for smart computing systems and their applications.
Game (Computer Game) is considered one of entertainment activities for many people. Therefore, several people have used technology to flee from technology as the usage rate has been increasing rapidly because of the emergence of the latest technology as well as the increasing speed of internet. In today’s world, technology is considered an essential service, similar to food and alcohol due to several benefits such as for daily activities and work. However, as the usage has been increased, video games or social media can also have advantages, which individuals should also avoid. Although many students use computers for study essentials, building technological skills for work place and learn to combat distraction and procrastination as part of that growth, it is still considered a waste of time especially for those who start to develop an addiction or use as a regular escapism. This paper concluded a number of the researches and facts about taking escapism with gaming too far.
Research suggests that video games can have both negative and positive effects. Studies investigating the adverse effects of games have found a short-term link between violent video games and minor forms of aggression. However, the effect size for this link is small, some of these studies suffer from methodological shortcomings, and recent research suggests games do not impact severe acts of violence. In addition, research examining whether games can be addictive is inconclusive. Scholars investigating the positive effects of games have found that they can alter negative moods, increase specific visuospatial skills, and provide healthy social interactions.
Although the validity of internet gaming disorder (IGD) in the DSM-5 hinges on a relationship between 5 or more IGD symptoms and “clinically significant impairment and/or distress”, to date most studies have focused on statistical significance. To address this, we conduct an individual participant meta-analysis comprised of primary data from 15 studies (n = 38,851). Study 1 finds that meeting the DSM-5's proposed 5/9 diagnostic threshold is associated with d = .65 greater distress across 21 well-being constructs, which exceeds a conservative anchor for clinical significance. However, we also find that classifying participants above and below the 5/9 threshold has little power to reject that threshold: a 2/9 cut-off predicts similarly large differences. Study 2 shows that dimensional (continuous) modelling of IGD scores offers a more severe test of the proposed threshold. Finally, study 3 reveals that three criteria—preoccupation, tolerance, and loss of control—are roughly half as predictive of distress as withdrawal and escapism, highlighting limitations also present in dimensional modelling and suggesting the need to modify or remove these. In sum, we do not find evidence for invalidating IGD as proposed, but do identify issues with threshold-based categorization, inadequate differentiation between statistical and clinical significance, and the inclusion of potentially flawed criteria. We argue that these are possible negative consequences of a premature switch to confirmatory research on IGD.
Two systematic reviews have been conducted to summarize the literature on Internet Gaming Disorder (IGD) and personality. However, the data was not synthesized statistically, imposing a limit to their conclusions. The current study aimed to extend on the two reviews by conducting a series of five meta-analyses, one for each of the Big Five personality factors, to examine their relationships with IGD. A comprehensive search was conducted on the databases PsycArticles, PsycInfo, and Web of Science from inception to 29 July 2021. The data was analyzed using Meta-Essentials and the random effects model was used to obtain the pooled estimate of the effect size. A total of 12 articles were included (n = 145 to 3389). IGD was not significantly correlated with openness to experience (r = -0.05). However, IGD was negatively correlated with conscientiousness (r = -0.29), extraversion (r = -0.15), and agreeableness (r = -0.17), and positively correlated with neuroticism (r = 0.20). Age moderated the relationships between IGD and openness to experience and conscientiousness. The results were broadly consistent with the DSM-5 IGD criteria and the Big Five personality framework. Future research directions might include examining age as moderator variables, and using appropriate instruments based on the DSM-5 IGD criteria.
La COVID-19 s’est accompagnée de mesures restrictives. Encourageant le maintien des liens sociaux chez les jeunes, l’OMS soutient l’initiative #PlayApartTogether (jouer ensemble à distance), malgré l’ajout récent de l’addiction aux jeux vidéo (JV) à la CIM-11. Une incompréhension peut naître du caractère paradoxal de ces deux messages.
Nous avons effectué une revue de la littérature internationale, afin d’argumenter les bénéfices et risques de la pratique du JV, durant cette crise sanitaire.
Il s’avère qu’il est difficile de dégager un consensus. Durant la pandémie, pratiquer des JV semble pouvoir favoriser un bien-être psychique de l’adolescent. Les JV, dits prosociaux, sont un moyen de maintenir le lien à l’autre. Certains JV, quant à eux, mobilisent physiquement. Souffrir au préalable d’anxiété ou de dépression peut mener vers une véritable addiction. La littérature non spécifique de la période COVID-19 fait état de l’amélioration des cognitions associées à une pratique régulière du JV. La pratique des JV prosociaux pourrait être bénéfiques sur le comportement ; alors, violence virtuelle et violence en vie réelle ne sont pas associées. Il n’a pas été établi de surrisque de suicide abouti chez les joueurs.
La littérature argumente le bénéfice de la pratique des JV actuellement. Ceux dits prosociaux sont à privilégier. Il faut, toutefois, rester attentif concernant le risque addictif, en particulier chez le jeune avec dépression préexistante ou nouvellement apparue, et ayant une grande conscience de l’impact du virus, éminemment anxiogène.
The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in
There is broad recognition of the importance of evidence in informing clinical decisions. When information from all studies included in a systematic review ("review") does not contribute to a meta-analysis, decision-makers can be frustrated. Our objectives were to use the field of eyes and vision as a case study and examine the extent to which authors of Cochrane reviews conducted meta-analyses for their review's pre-specified main outcome domain and the reasons that some otherwise eligible studies were not incorporated into meta-analyses.
We examined all completed systematic reviews published by Cochrane Eyes and Vision, as of August 11, 2017. We extracted information about each review's outcomes and, using an algorithm, categorized one outcome as its "main" outcome. We calculated the percentage of included studies incorporated into meta-analyses for any outcome and for the main outcome. We examined reasons for non-inclusion of studies into the meta-analysis for the main outcome.
We identified 175 completed reviews, of which 125 reviews included two or more studies. Across these 125 reviews, the median proportions of studies incorporated into at least one meta-analysis for any outcome and for the main outcome were 74% (interquartile range [IQR] 0-100%) and 28% (IQR 0-71%), respectively. Fifty-one reviews (41%) could not conduct a meta-analysis for the main outcome, mostly because fewer than two included studies measured the outcome (21/51 reviews) or the specific measurements for the outcome were inconsistent (16/51 reviews).
Outcome choice during systematic reviews can lead to few eligible studies included in meta-analyses. Core outcome sets and improved reporting of outcomes can help solve some of these problems.
Previous large-scale studies suggest that internet gaming disorder (IGD) among children and adolescents has become an important public concern. Minors are known to be particularly susceptible to problematic internet gaming use owing to age-related underdevelopment of cognitive control. It has been shown that precursors of addictions appear during adolescence; therefore, prevention efforts must be established targeting minors who have their first experience with addictive substances and behaviors during pubescence. Since the DSM-5 classification of IGD in 2013, studies on IGD have drastically increased in number. Thus, we performed an updated review of studies of IGD in children and adolescents to assess the clinical implications of IGD. The search included all publication years, using PubMed, MEDLINE, and PsycINFO. Across studies, the presence of IGD had a negative effect on sleep and schoolwork in minors. Additionally, family factors, including the quality of parent-child relationships, were important social factors in minors with IGD. Brain imaging studies indicate that impaired cognitive control in minors with IGD is associated with abnormal function in the prefrontal cortex and striatum. Persistent pathological online game use from childhood may aggravate abnormal brain function; therefore, preventive care and early intervention are increasingly important. Although extant research supports the effectiveness of cognitive behavioral therapy for minors with IGD, effective psychological intervention for minors with IGD is an urgent issue that requires further research. This review, which presents updated findings of IGD in minors, is expected to contribute to the development of future research and be useful in clinical practice in the field of child and adolescent psychiatry.
The Internet is now all-pervasive across much of the globe. While it has positive uses (e.g. prompt access to information, rapid news dissemination), many individuals develop Problematic Use of the Internet (PUI), an umbrella term incorporating a range of repetitive impairing behaviours. The Internet can act as a conduit for, and may contribute to, functionally impairing behaviours including excessive and compulsive video gaming, compulsive sexual behaviour, buying, gambling, streaming or social networks use. There is growing public and National health authority concern about the health and societal costs of PUI across the lifespan. Gaming Disorder is being considered for inclusion as a mental disorder in diagnostic classification systems, and was listed in the ICD-11 version released for consideration by Member States (http://www.who.int/classifications/icd/revision/timeline/en/). More research is needed into disorder definitions, validation of clinical tools, prevalence, clinical parameters, brain-based biology, socio-health-economic impact, and empirically validated intervention and policy approaches. Potential cultural differences in the magnitudes and natures of types and patterns of PUI need to be better understood, to inform optimal health policy and service development. To this end, the EU under Horizon 2020 has launched a new four-year European Cooperation in Science and Technology (COST) Action Programme (CA 16207), bringing together scientists and clinicians from across the fields of impulsive, compulsive, and addictive disorders, to advance networked interdisciplinary research into PUI across Europe and beyond, ultimately seeking to inform regulatory policies and clinical practice. This paper describes nine critical and achievable research priorities identified by the Network, needed in order to advance understanding of PUI, with a view towards identifying vulnerable individuals for early intervention. The network shall enable collaborative research networks, shared multinational databases, multicentre studies and joint publications.
Mental and behavioral health recovery includes concepts related not just to symptom improvement, but also to participating in activities that contribute to wellness and a meaningful life. Video game play can relieve stress and provide a way to connect, which may be especially important for military veterans.
We examined how military veterans used video game play to further their mental and behavioral health recovery by conducting an exploratory thematic analysis of the gaming habits of 20 United States military veterans who were in treatment for mental or behavioral health problems.
We conducted semi-structured interviews in 2016 and used a framework analytic approach to determine salient themes linking video gaming to mental and behavioral health recovery.
Veteran participants reported that video games helped not only with managing moods and stress, but also with three areas related to other aspects of recovery: adaptive coping (e.g. distraction, control, symptom substitution); eudaimonic well-being (confidence, insight, role functioning); and socializing (participation, support, brotherhood). Meaning derived from game narratives and characters, exciting or calming gameplay, and opportunities to connect, talk, and lead others were credited as benefits of gaming. Responses often related closely to military or veteran experiences. At times, excessive use of games led to life problems or feeling addicted, but some veterans with disabilities felt the advantages of extreme play outweighed these problems.
Video games seem to provide some veterans with a potent form of "personal medicine" that can promote recovery. Although reasons and results of gaming may vary within and among individuals, clinicians may wish to discuss video game play with their patients to help patients optimize their use of games to support recovery.
The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.
Patient care and clinical practice guidelines should be informed by evidence from reliable systematic reviews. The reliability of systematic reviews related to forthcoming guidelines for retina and vitreous conditions is unknown.
To summarize the reliability of systematic reviews on interventions for 7 retina and vitreous conditions, describe characteristics of reliable and unreliable systematic reviews, and examine the primary area in which they appeared to be lacking.
Design, Setting, and Participants
A cross-sectional study of systematic reviews was conducted. Systematic reviews of interventions for retina- and vitreous-related conditions in a database maintained by the Cochrane Eyes and Vision United States Satellite were identified. Databases that the reviewers searched, whether any date or language restrictions were applied, and bibliographic information, such as year and journal of publication, were documented. The initial search was conducted in March 2007, and the final update was performed in July 2018. The conditions of interest were age-related macular degeneration; diabetic retinopathy; idiopathic epiretinal membrane and vitreomacular traction; idiopathic macular hole; posterior vitreous detachment, retinal breaks, and lattice degeneration; retinal and ophthalmic artery occlusions; and retinal vein occlusions. The reliability of each review was evaluated using prespecified criteria. Data were extracted by 2 research assistants working independently, with disagreements resolved through discussion or by 1 research assistant with verification by a senior team member.
Main Outcomes and Measures
Proportion of reviews that meet all of the following criteria: (1) defined eligibility criteria for study selection, (2) described conducting a comprehensive literature search, (3) reported assessing risk of bias in included studies, (4) described using appropriate methods for any meta-analysis performed, and (5) provided conclusions consistent with review findings.
A total of 327 systematic reviews that addressed retina and vitreous conditions were identified; of these, 131 reviews (40.1%) were classified as reliable and 196 reviews (59.9%) were classified as not reliable. At least 1 reliable review was found for each of the 7 retina and vitreous conditions. The most common reason that a review was classified as not reliable was lack of evidence that a comprehensive literature search for relevant studies had been conducted (149 of 196 reviews [76.0%]).
Conclusion and Relevance
The findings of this study suggest that most systematic reviews that addressed interventions for retina and vitreous conditions were not reliable. Systematic review teams and guideline developers should work with information professionals who can help navigate sophisticated and varied syntaxes required to search different resources.
The revised edition of the Handbook offers the only guide on how to conduct, report and maintain a Cochrane Review ? The second edition of The Cochrane Handbook for Systematic Reviews of Interventions contains essential guidance for preparing and maintaining Cochrane Reviews of the effects of health interventions. Designed to be an accessible resource, the Handbook will also be of interest to anyone undertaking systematic reviews of interventions outside Cochrane, and many of the principles and methods presented are appropriate for systematic reviews addressing research questions other than effects of interventions. This fully updated edition contains extensive new material on systematic review methods addressing a wide-range of topics including network meta-analysis, equity, complex interventions, narrative synthesis, and automation. Also new to this edition, integrated throughout the Handbook, is the set of standards Cochrane expects its reviews to meet. Written for review authors, editors, trainers and others with an interest in Cochrane Reviews, the second edition of The Cochrane Handbook for Systematic Reviews of Interventions continues to offer an invaluable resource for understanding the role of systematic reviews, critically appraising health research studies and conducting reviews.
Assessment of risk of bias is regarded as an essential component of a systematic review on the effects of an intervention. The most commonly used tool for randomised trials is the Cochrane risk-of-bias tool. We updated the tool to respond to developments in understanding how bias arises in randomised trials, and to address user feedback on and limitations of the original tool.
Patient care should be informed by clinical practice guidelines, which in turn should be informed by evidence from reliable systematic reviews. The American Academy of Ophthalmology is updating its Preferred Practice Patterns (PPPs) for the management of the following 6 corneal diseases: bacterial keratitis, blepharitis, conjunctivitis, corneal ectasia, corneal edema and opacification, and dry eye syndrome.
To summarize the reliability of the existing systematic reviews addressing interventions for corneal diseases.
The Cochrane Eyes and Vision US Satellite database.
In this study of published systematic reviews from 1997 to 2017 (median, 2014), the Cochrane Eyes and Vision US Satellite database was searched for systematic reviews evaluating interventions for the management of any corneal disease, combining eyes and vision keywords and controlled vocabulary terms with a validated search filter.
Data Extraction and Synthesis
The study classified systematic reviews as reliable when each of the following 5 criteria were met: the systematic review specified eligibility criteria for inclusion of studies, conducted a comprehensive literature search for studies, assessed risk of bias of the individual included studies, used appropriate methods for quantitative syntheses (meta-analysis) (only assessed if meta-analysis was performed), and had conclusions that were supported by the results of the systematic review. They were classified as unreliable if at least 1 criterion was not met.
Main Outcomes and Measures
The proportion of systematic reviews that were reliable and the reasons for unreliability.
This study identified 98 systematic reviews that addressed interventions for 15 corneal diseases. Thirty-three of 98 systematic reviews (34%) were classified as unreliable. The most frequent reasons for unreliability were that the systematic review did not conduct a comprehensive literature search for studies (22 of 33 [67%]), did not assess risk of bias of the individual included studies (13 of 33 [39%]), and did not use appropriate methods for quantitative syntheses (meta-analysis) (12 of 17 systematic reviews that conducted a quantitative synthesis [71%]). Sixty-five of 98 systematic reviews (66%) were classified as reliable. Forty-two of the 65 reliable systematic reviews (65%) addressed corneal diseases relevant to the 2018 American Academy of Ophthalmology PPPs; 33 of these 42 systematic reviews (79%) are cited in the 2018 PPPs.
Conclusions and Relevance
One in 3 systematic reviews addressing interventions for corneal diseases are unreliable and thus were not used to inform PPP recommendations. Careful adherence by systematic reviewers and journal editors to well-established best practices regarding systematic review conduct and reporting might help make future systematic reviews in eyes and vision more reliable.