Evidence map›Paper›PMID 42835583›Full record

ArticleOphthalmology science2026

Win Ratios in Ophthalmology-a Hierarchical Metric to Evaluate Adverse Outcomes in Comparative Studies.

Jeremy C K Tan, George Kong, David Wechsler, David Manning, Hamish Dunn, Brian Chua, Helen Danesh-Meyer, Louis Arnould, Gus Gazzard, Mitchell Lawlor

Abstract read
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In one paragraph

Article in Ophthalmology science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing 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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

10 authors.

Jeremy C K TanSave Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
George KongGlaucoma Investigation and Research Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
David WechslerSave Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
David ManningSave Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Hamish DunnSave Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Brian ChuaSave Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Helen Danesh-MeyerFaculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Louis ArnouldDepartment of Ophthalmology, Dijon University Hospital, Dijon, France.
Gus GazzardNational Institute for Health and Care Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom.
Mitchell LawlorSave Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Purpose: Clinical trials in ophthalmology frequently report multiple efficacy and safety outcomes of varying clinical importance analyzed either in isolation or as simple composites. The Win Ratio (WR) is a hierarchical composite metric originally developed to address such limitations in cardiovascular research by integrating outcomes according to their clinical priority. In this study, we assess its potential utility in ophthalmology outcomes with glaucoma surgery as the exemplar. Design: Retrospective registry-based study. Subjects: There are 1257 eyes that underwent a Xen gel stent (Xen) implantation or trabeculectomy (Trab) with a minimum 12 months of follow-up. Methods: Propensity score matching yielded two comparable cohorts (212 eyes each) without significant differences in age, baseline intraocular pressure, number of medications, visual acuity, or visual field mean deviation. A predefined hierarchy of eight adverse outcomes was constructed, headed by loss of light perception vision, secondary glaucoma surgery, followed by early postoperative complications (e.g., hypotony and hyphaema) or bleb needling. Each Xen-Trab pair was evaluated sequentially and classified as a win, loss, or tie. Main outcome measures: The overall WR with 95% confidence intervals (CIs) and Results: The Xen group accumulated fewer wins than Trab (WR 0.83, 95% CI 0.63-1.10, Conclusions: The WR offers a clinically meaningful, hierarchical approach to comparing multidimensional treatments that respects clinical priorities. Our findings illustrate the potential utility of this metric in the prospective evaluation of trial outcomes in ophthalmology. Financial Disclosures: The authors have no proprietary or commercial interest in any materials discussed in this article.

Indexed as

Glaucoma filtration surgeryMinimally invasive glaucoma surgeryTrabeculectomyXen45 gel stent

Identifiers

PMID42835583
PMCPMC13636062

What OpenQuestion holds

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Registered trials

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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.