Evidence map›Paper›PMID 39033242›Full record

SynthesisEye (London, England)2024

Exploring the fragility of meta-analyses in ophthalmology: a systematic review.

Keean Nanji, Jim Xie, Amin Hatamnejad, Daiana R Pur, Mark Phillips, Dena Zeraatkar, Tien Yin Wong, Robyn H Guymer, Peter K Kaiser, Sobha Sivaprasad and 4 more

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Eye (London, England), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Keean NanjiDepartment of Surgery, Division of Ophthalmology, McMaster University, Hamilton, ON, Canada.
Jim XieDepartment of Surgery, Division of Ophthalmology, McMaster University, Hamilton, ON, Canada.
Amin HatamnejadDepartment of Surgery, Division of Ophthalmology, McMaster University, Hamilton, ON, Canada.ORCID http://orcid.org/0000-0002-4714-738X
Daiana R PurSchulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Mark PhillipsDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Dena ZeraatkarDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Tien Yin WongSingapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.ORCID http://orcid.org/0000-0002-8448-1264
Robyn H GuymerCentre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
Peter K KaiserCole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.ORCID http://orcid.org/0000-0001-5126-045X
Sobha SivaprasadNIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
Mohit BhandariDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
David H SteelBioscience Institute, Newcastle University, Newcastle Upon Tyne, UK.
Charles C WykoffRetina Consultants of Texas, Houston, TX, USA.ORCID http://orcid.org/0000-0001-7756-5091
Varun ChaudharyDepartment of Surgery, Division of Ophthalmology, McMaster University, Hamilton, ON, Canada. vchaudh@mcmaster.ca.ORCID http://orcid.org/0000-0002-9988-4146

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe fragility index (FI) of a meta-analysis evaluates the extent that the statistical significance can be changed by modifying the event status of individuals from included trials. Understanding the FI improves the interpretation of the results of meta-analyses and can help to inform changes to clinical practice. This review determined the fragility of ophthalmology-related meta-analyses.

methodsMeta-analyses of randomized controlled trials with binary outcomes published in a journal classified as 'Ophthalmology' according to the Journal Citation Report or an Ophthalmology-related Cochrane Review were included. An iterative process determined the FI of each meta-analysis. Multivariable linear regression modeling evaluated the relationship between the FI and potential predictive factors in statistically significant and non-significant meta-analyses.

results175 meta-analyses were included. The median FI was 6 (Q1-Q3: 3-12). This meant that moving 6 outcomes from one group to another would reverse the study's findings. The FI was 1 for 18 (10.2%) of the included meta-analyses and was ≤5 for 75 (42.4%) of the included meta-analyses. The number of events (p < 0.001) and the p-value (p < 0.001) were the best predictors of the FI in both significant and non-significant meta-analyses.

conclusionThe statistical significance of meta-analyses in ophthalmology often hinges on the outcome of a few patients. The number of events and the p-value are the most important factors in determining the fragility of the evidence. The FI is an easily interpretable measure that can supplement the reader's understanding of the strength of the evidence being presented. PROSPERO REGISTRATION: CRD42022377589.

Indexed as

Meta-Analysis as TopicOphthalmologyHumansRandomized Controlled Trials as Topic

Identifiers

PMID39033242
PMCPMC11543934

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.