title: Methodologic rigor of clinical trials on surgical management of eyes with coexisting cataract and glaucoma.
abstract: OBJECTIVE
  To assess the methodologic quality of published studies of the surgical management of coexisting cataract and glaucoma.
  
  
  METHODS
  Literature review and analysis.
  
  
  METHODS
  We performed a systematic search of the literature to identify all English language articles pertaining to the surgical management of coexisting cataract and glaucoma in adults. Quality assessment was performed on all randomized controlled trials, nonrandomized controlled trials, and cohort studies. Overall quality scores and scores for individual methodologic domains were based on the evaluations of two experienced investigators who independently reviewed articles using an objective quality assessment form.
  
  
  METHODS
  Quality in each of five domains (representativeness, bias and confounding, intervention description, outcomes and follow-up, and statistical quality and interpretation) measured as the percentage of methodologic criteria met by each study.
  
  
  RESULTS
  Thirty-six randomized controlled trials and 45 other studies were evaluated. The mean quality score for the randomized, controlled clinical trials was 63% (range, 11%-88%), and for the other studies the score was 45% (range, 3%-83%). The mean domain scores were 65% for description of therapy (range, 0%-100%), 62% for statistical analysis (range, 0%-100%), 58% for representativeness (range, 0%-94%), 49% for outcomes assessment (range, 0%-83%), and 30% for bias and confounding (range, 0%-83%). Twenty-five of the studies (31%) received a score of 0% in the bias and confounding domain for not randomizing patients, not masking the observers to treatment group, and not having equivalent groups at baseline.
  
  
  CONCLUSIONS
  Greater methodologic rigor and more detailed reporting of study results, particularly in the area of bias and confounding, could improve the quality of published clinical studies assessing the surgical management of coexisting cataract and glaucoma.
mesh_terms: D002386:Cataract / Q000150:complications*; D002387:Cataract Extraction; D002986:Clinical Trials as Topic; D005901:Glaucoma / Q000150:complications* / Q000601:surgery*; D006801:Humans; D012107:Research Design