Systemic reviews of glaucoma treatments by at least one author with a conflict of interest (COI) may be more likely to have favorable conclusions about the investigated intervention, new research reports. The study, published in the Journal of Glaucoma, found COIs are common, yet often undisclosed, among authors of ophthalmologic systemic reviews; as such, the investigators suggest the need to reform the current COI definitions and disclosure policies to increase transparency.

The research paper also found industry support didn’t appear to influence the results or conclusions of the studies. 

The investigation included 26 systemic reviews conducted by 108 authors from 2016 to 2020. The researchers located author conflicts of interest from multiple databases including CMS Open Payments Database, Dollars for Profs, Google Patents, the United States Patent and Trademark Office USPTO, and previously published disclosure statements. Study sponsorship was determined using each review’s funding disclosure statement.

Out of the 26 systemic reviews, nine (35%) were conducted by at least one author with an undisclosed COI. Out of the nine studies in question, three (33%) reported results favoring the treatment group, and five (56%) had conclusions favoring the treatment group. Of the 17 systematic reviews with no conflicted authors, only one (6%) included results favoring the treatment group, and two (12%) reported conclusions favoring the treatment group.

Given the influence that author COI may have on study outcomes, several influential stakeholders in academic medicine have tried to improve the accuracy of author disclosure, the investigators explained.

For example, the International Committee of Medical Journal Editors (ICMJE)

developed a standardized author COI disclosure form used by all of its member journals. Although many medical journals now use this standard form, others have different COI disclosure policies and requirements, researchers noted.  A study of 130 high-impact journals across a variety of medical specialties found that 99% required authors to disclose COIs, but only 45% of journals required authors to adhere to ICMJE policies and recommendations.

 Moreover, the definition of a COI varies greatly across disclosure policies, leaving authors unsure what warrants disclosure at the time of journal submission, researchers said.

Even the ICMJE COI disclosure guideline has drawn criticism for its ambiguous language, such as “potential conflicts of interest” and “relevant financial activities, the study noted. In an editorial published in the American Journal of Ophthalmology, the journal’s editors argue that such language is “ambiguous, problematic, and confusing” because of the inherent subjectiveness on the part of the author when deciding on the relevancy of a potential competing interest.

Disclosure policies also offer little benefit if authors cannot be held accountable, the authors said.

Wise A, Mannem D, Anderson MJ, et al. Do author conflicts of interest and industry sponsorship influence outcomes of systematic reviews and meta-analyses regarding glaucoma interventions? A cross-sectional analysis. Journal of Glaucoma. Feb. 1, 2021 [E-pub, ahead of print].