Cochrane Eyes and Vision Priority Setting Exercise

The goal of this project was to generate and publicise a list of priority topics, for both new and updated reviews, ensuring the involvement of our main stakeholders.

What did we do?

We established a Steering Group including ophthalmologists, optometrists, orthoptists, ophthalmic nurses, relevant professional bodies, consumers and patient organisations, experienced clinical editors, systematic review methodologists, and information specialists.

To identify potential systematic review questions, we first searched global policy reports, other research prioritisation exercises and roadmaps, guidelines, systematic review databases, and intervention studies on The Cochrane Library (CENTRAL). We grouped questions by condition (e.g., cataract, refractive error, glaucoma) and conducted a two-round online Delphi survey to identify priority review questions.

Participants in the online survey were recruited by social media and through the networks of the Steering Group: 343 people took part in Round 1 and 160 took part in both Round 1 and Round 2. Participants included eye care practitioners (69%), researchers (37%), patients and carers (24%), research provider/funders (5%) and non-eye health care practitioner (4%). Participants were from all WHO regions with a majority from the European region (62%).

What did we find?

The top five questions for each condition group are listed below.

What did we find?

The top five questions for each condition group are listed below.

How should prospective review teams use this list?

Proposals for Cochrane Reviews should be submitted to Cochrane following the instructions here.

The review topics listed below may be used as a starting point when developing a proposal for a Cochrane Review. In order to minimise duplication of effort, review author teams need to consider current and past reviews on the topic and ensure that the proposed review is focussed on the key question that can be answered by a systematic review. We advise following the PICO framework for intervention reviews with careful consideration of Population, Interventions, Comparator and Outcome. This framework may be modified for other review types (prognostic reviews - population, index factor, comparator, outcomes, timing and diagnostic test accuracy reviews - population, index test, target condition, setting). A clear idea of the number of available studies likely to be included in the review is also important; reviews with very few or no studies are less likely to be accepted.

Updates of reviews on The Cochrane Library would usually be undertaken by the same review team but there may be opportunities for collaboration in these situations. Work on some of the review topics listed below may be underway. Please contact Alison Liu (suhsun.liu@cuanschutz.edu) prior to developing a proposal to check whether the review question is likely to be available.

Cataract

Question

Interventions to improve access to, and/or affordability of, cataract surgery 

Interventions to improve training of cataract surgeons and/or support staff 

Interventions to improve monitoring of outcomes after cataract surgery 

Interventions to improve integration of cataract and refractive error services 

Interventions for improving outcomes after complicated cataract surgery 

Refractive Error

Question

Models to increase uptake and access to refraction and optical services

Practitioner training for identification of refractive error and vision problems

Prescribing guidelines for spectacles to improve vision outcomes

Prognostic factors for the development and progression of refractive error

Interventions for presbyopia

A number of participants highlighted the importance of assessing the evidence for interventions to halt or slow down the progression of myopia, particularly in children. This question has not been included in the top five list of questions because a new Cochrane review on this topic will be published in January 2023. This will be a "living systematic review" which means that the review authors plan to search the literature every six months and incorporate new evidence as it becomes available. 

Diabetic retinopathy

Question

Integration of diabetic eye care services within the health service

Barriers that prevent diabetic patients having regular eye checks

Interventions to increase attendance for diabetic retinopathy screening

Artificial intelligence for screening and/or diagnosis of diabetic retinopathy

Non-invasive treatments for slowing down progression of diabetic retinopathy

Glaucoma

Question

Monitoring glaucoma to prevent progression, including with telemetry 

Interventions to improve the referral pathway for glaucoma 

Prognostic risk factors for glaucoma development and progression 

Artificial intelligence for screening and/or diagnosis of glaucoma 

Optical coherence tomography for the diagnosis and monitoring of glaucoma 

Macular disease

Question

Safety and efficacy of different drug delivery systems for treatment of AMD

Interventions to improve the capacity and productivity of wet AMD pathways

Telemedicine for the diagnosis and monitoring of AMD

Educational interventions for wellbeing/quality of life for people with AMD

Prognostic factors for the development and progression of AMD

Other retinal conditions

Question

Prognostic factors for the outcome of surgery for epiretinal membranes

Interventions to reduce risk of sight loss in retinal detachments

Wide-angle imaging to detect retinal detachment in non-eyecare settings

Interventions to prevent proliferative vitreoretinopathy in retinal detachment surgery

Prognostic factors for visual loss in inherited retinal diseases

Ocular surface

Question

Interventions for dry eye

Interventions for corneal diseases/dystrophies

Interventions to improve the outcomes of corneal transplantation

Prognostic factors for development of dry eye syndrome, including biomarkers

Diagnostic tests for dry eye syndrome, including biomarkers

Eyelid and lacrimal system

Question

Interventions for lacrimal duct obstruction 

Interventions for ptosis 

Interventions for cancers involving the eyelid 

Interventions for blepharitis and meibomian gland dysfunction 

Interventions for entropion 

Neuro-ophthalmology

Question

Interventions for optic neuritis not associated with multiple sclerosis

Prognostic factors for visual field loss in acquired brain injury

Screening for cerebral visual impairment

Interventions for idiopathic intracranial hypertension

Prognostic factors for vision loss in intracranial hypertension

Infection and inflammation

Question

Prevention of corneal infections in contact lens wearers

Interventions for infectious uveitis

Interventions for non-infectious uveitis

Prognostic factors for the development and progression of uveitis

Interventions for the prevention and treatment of recurrent ophthalmic herpes

Children

Question

School vision screening programmes (methods and impact) 

Prognostic factors for development/ progression of refractive error in children

Screening for amblyopia during vaccination programs for rural communities 

Interventions for amblyopia 

Screening for retinoblastoma 

A number of participants highlighted questions relating to screening and treatment of retinopathy of prematurity. These questions have not been included in the top five list of questions here because retinopathy of prematurity is within the scope of Cochrane Neonatal rather than Cochrane Eyes and Vision.

Rehabilitation 

Question

Interventions to improve access and affordability of visual rehabilitation 

Models of rehabilitation including integration with eye care 

Assistive technology for adults and children with low vision

Psychological interventions to support living with visual impairment 

Impact of vision loss on quality life 

General

Question

Telemedicine to improve referral from primary to secondary care

Artificial intelligence to improve referral from primary to secondary care

Models for out-of-hours emergency eye care

Simultaneous detection of all major eye conditions

Diagnosis and management of eye disease by non-ophthalmologists