title: The methodological quality of systematic reviews comparing intravitreal bevacizumab and alternates for neovascular age related macular degeneration: A systematic review of reviews.
abstract: OBJECTIVE
  To systematically collate and evaluate the evidence from recent SRs of bevacizumab for neo-vascular age related macular degeneration.
  
  
  METHODS
  Literature searches were carried out in Medline, Embase, Cochrane databases for all systematic reviews (SRs) on the effectiveness of bevacizumab for neo-vascular age related macular degeneration, published between 2000 and 2013. Titles and abstracts were assessed against the inclusion/exclusion criteria using Joanna Briggs Institute (JBI) study eligibility form. Data was extracted using the JBI data extraction form. The quality of the SRs was assessed using JBI critical appraisal checklist for SRs. Decisions on study eligibility and quality were made by two reviewers; any disagreements were resolved by discussion.
  
  
  RESULTS
  Nine relevant reviews were identified from 30 citations, of which 5 reviews fulfilled the review's inclusion criteria. All 5 reviews showed bevacizumab to be effective for neovascular AMD in the short-term when used alone or in combination with PDT or Pegaptanib. The average quality score of the reviews was 7; 95% confidence interval 6.2 to 7.8 (maximum possible quality score is 10). The selection and publication bias were not addressed in all included reviews. Three-fifth of the reviews had a quality score of 7 or lower, these reviews had some methodological limitations, search strategies were only identified in 2 (40%) reviews, independent study selection and quality assessment of included studies (4 (80%)) were infrequently performed.
  
  
  CONCLUSIONS
  Overall, the reviews on the effectiveness of intravitreal/systemic bevacizumab for neovascular  age-related macular generation (AMD) received good JBI quality scores (mean score = 7.0 points), with a few exceptions. The study also highlights the suboptimal reporting of SRs on this topic. Reviews with poor methodology may limit the validity of the reported results; hence efforts should be made to improve the design, reporting and publication of SRs across all journals.
authors.affiliation: Health Services and Outcomes Research, National Healthcare Group HQ, Singapore.
authors.forename: Pradeep Paul
authors.initials: PP
authors.lastname: George
authors.forename: Joseph Antonio
authors.initials: JA
authors.lastname: DeCastro Molina
authors.forename: Bee Hoon
authors.initials: BH
authors.lastname: Heng
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D052157:Aptamers, Nucleotide / Q000008:administration & dosage*; D000068258:Bevacizumab / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy*; D015861:Retinal Neovascularization / Q000188:drug therapy*; D042461:Vascular Endothelial Growth Factor A
chemical_list: D020533:Angiogenesis Inhibitors; D052157:Aptamers, Nucleotide; D042461:Vascular Endothelial Growth Factor A; C495058:pegaptanib; D000068258:Bevacizumab