Equity was rarely considered in Cochrane Eyes and Vision systematic reviews and primary studies on cataract

Inequities in glaucoma research: an analysis of Cochrane systematic reviews and randomized trials

OBJECTIVES

To understand the level of equity considerations within Cochrane systematic reviews (CSR) on glaucoma and their primary studies.

METHODS

A review of equity considerations in systematic reviews on glaucoma published in The Cochrane Library from inception (2003) to January 31, 2024 and a sample of recently published primary studies included in those reviews (n = 122). Extraction was performed by two independent reviewers using a prepiloted extraction form based on a validated, contemporary, structured equity framework. If consensus could not be reached, a third reviewer was involved.

RESULTS

A total of 40 CSRs on glaucoma were identified, all of which exclusively included randomized control trials (RCTs) or quasi-RCTs. Twenty-nine (72.5%) reviews acknowledged populations experiencing inequities in glaucoma care; none were able to perform subgroup analysis due to data unavailability in primary studies. Six (15.0%) reviews considered equity-relevant factors when discussing applicability or limitations of study findings to specific populations. Seventy-four (46.8%) review authors were women, while 84 (53.2%) were men. Most review authors were primarily affiliated with institutions in the European Region (85, 53.8%) or the Americas (55, 34.8%), while none were primarily affiliated with institutions in Africa or low-income countries. Most RCTs were conducted in the Americas (32.8%), European Region (27.9%), or in high-income countries (72.1%). While most RCTs reported gender or sex of participants (107, 87.7%), only half reported race or ethnicity (61, 50.0%). No RCTs reported place of residence, occupation, socioeconomic status (SES), or social capital of participants. Approximately half (51.7%) of the participants in these RCTs were female.

CONCLUSION

Equity considerations can be better addressed in research on glaucoma. Reporting of patient sociodemographic in RCTs, particularly race and ethnicity, as well as global representation were insufficient. This may limit the generalizability and applicability of intervention efficacy to populations experiencing inequities and people from low-income countries.

Evaluating equity reporting within systematic reviews of pre-exposure prophylaxis (PrEP)

BACKGROUND

Pre-exposure prophylaxis (PrEP) is a medicine that can reduce HIV transmission. Given the disproportionate impact of HIV on minority communities, health equity is an important consideration in PrEP research. We aimed to assess equity reporting in systematic reviews of PrEP using the PROGRESS Plus framework.

METHODS

We conducted a systematic search of PubMed (MEDLINE), Embase and Cochrane databases for systematic reviews or meta analyses of PrEP usage. We then used the PROGRESS Plus framework to extract inclusion of the following domains: place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, social capital, age and disability.

RESULTS

After screening search articles, our sample included 36 systematic reviews and meta-analyses (SRMAs). 24 (66.7%) were conducted within the USA. Few (2/36, 5.6%) were found to mention adherence to any equity reporting framework. Place and gender/sex were the most reported elements of the framework with inclusion in 34 of 36 studies. Age (30/36, 83.3%) and race/ethnicity (24/36, 66.7%) were also commonly reported. All other criteria were reported in less than half of included SRMAs; religion had the lowest inclusion at 0/36 (0%), followed by disability (1/36, 2.8%). Among the 36 SRMAs, 19 (52.78%) did not conduct any subgroup analyses among domains; those most commonly analysed were gender/sex and age.

CONCLUSION

Our study found nearly all SRMAs regarding HIV PrEP reported on gender/sex and age; however, other influential equity criteria were often overlooked. Further attention to the reporting of PROGRESS Plus items within these SRMAs may reduce barriers for PrEP utilisation, thus improving HIV prevention strategies.

IL-8 promotes lens capsular residual cells migration by down-regulates expression of E-cadherin and ZO-1 via the CXCR1/2-NF-κB-RhoA signal pathway

BACKGROUND

Posterior capsular opacification is a major complication following cataract surgery, marked by proliferation, migration, epithelial-mesenchymal transition, and fibrosis of residual epithelial cells. Various inflammatory cytokines are upregulated and contribute to the development of posterior capsular opacification. The effect of interleukin-8 on residual epithelial cells has not been fully determined.

METHODS

Aqueous humor and anterior capsules samples were collected from cataract surgery. Capsular bags from rats and pigs were cultured in DMEM media. Protein and mRNA expressions were measured using immunoblot and qPCR. Cell migration was assessed using the transwell assay.

RESULTS

Interleukin-8 is an early inflammatory factor secreted by residual lens epithelial cells. Migration of lens epithelial cells in aqueous humor positively correlates with interleukin-8 levels, and this effect is inhibited by the receptors of interleukin-8 CXCR1/2 blocker Reparaxin. The expression of tight-junction protein ZO-1 and cell-adhesion protein E-cadherin were down-regulated by administrating interleukin-8, and cell migration of both SRA01/04 cell line in vitro and capsular residual epithelial cells ex vivo were up-regulated via activating RhoA expression and RhoA/GTPase activity. The loss-of- function studies demonstrate that interleukin-8 binding to its receptor CXCR1/2 activates NF-κB/p65, which then turns on the RhoA's expression and RhoA/GTPase activity, and RhoA-modulated the downexpression of E-cadherin and ZO-1 and the increase of cell migration.

CONCLUSIONS

The upregulation in interleukin-8 occurs early in posterior capsular opacification and contributes to down-regulating tight-junctions among epithelial cells and elevates cell migration via the CXCR1/2-NF-κB-RhoA signaling pathway. These demonstrated that interleukin-8 could be a potential target for preventing posterior capsular opacification.

A review of health equity considerations in Cochrane reviews of lifestyle interventions for cardiovascular health in adults

OBJECTIVES

Cardiovascular disease (CVD) is the leading cause of global disease burden and rising health-care costs. Systematic reviews (SRs) rigorously evaluate evidence on health interventions' effects and guide personal, clinical, and policy decision-making. Health equity is the absence of avoidable and unfair differences in health between groups within a population. Assessing equity in lifestyle interventions for cardiovascular health is important due to persisting health inequities in CVD burden and access to interventions. We aim to explore how health equity considerations are addressed in Cochrane SRs of lifestyle interventions for cardiovascular health.

STUDY DESIGN AND SETTING

This is a methodological review of Cochrane SRs of lifestyle interventions for cardiovascular health using the PROGRESS-Plus framework. PROGRESS-Plus stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital, while "Plus" stands for additional factors associated with discrimination and exclusion such as age, disability, and comorbidity. Using predefined selection criteria, two authors independently screened all Cochrane reviews published in the Cochrane Database of Systematic Reviews (CDSR) between August 2017 and December 2022. PROGRESS-Plus factors in the SRs were sought in the Summary of Findings (SoF) table, Methods/Inclusion criteria, Methods/Subgroup analyses, Results/Included studies, Results/Subgroup analyses, and Discussion/Overall completeness and applicability of evidence.

RESULTS

We included 36 SRs published by 10 Cochrane groups, addressing 11 health conditions with mostly dietary and exercise interventions. The most common PROGRESS-Plus factors assessed were gender/sex, age, and comorbidity. PROGRESS-Plus factors were most addressed in the inclusion criteria (64%), the discussion (75%), and the included studies (92%) sections of the SRs. Only 33% of SoF tables referenced PROGRESS-Plus. Sixty-nine percent of the included SRs planned for subgroup analyses across one or more PROGRESS-Plus factors, but only 43% of SRs conducted subgroup analyses, suggesting limited reporting of PROGRESS-Plus factors in primary studies.

CONCLUSION

Equity factors are not sufficiently addressed in Cochrane reviews of lifestyle interventions for cardiovascular health. Low reporting of PROGRESS-Plus factors in implications for practice and research sections of Cochrane SRs limit equity-focused guidance for current clinical practice, public health interventions, and future research.

Geographic Representation of Authorship in Ophthalmic Research from Low- and Middle-Income Countries

PURPOSE

Low- and middle-income countries (LMICs) are underrepresented in ophthalmic research, despite carrying the highest burden of visual impairment. To assess the representation of local authors in global ophthalmic research, this cross-sectional, bibliometric analysis measured the proportion of LMIC-affiliated authorship in LMIC-based ophthalmic research.

METHODS

We sampled original, primary research conducted in LMICs and published in 1 of 7 high-impact ophthalmic journals between 2017 and 2021. For each article, we extracted the number and name of country study site(s), country affiliation(s) of first and last author, proportion of LMIC-affiliated authors, funding sources, and study design.

RESULTS

Of the 1,333 studies exclusively conducted in LMICs, 89.4% of first authors and 80.6% of last authors were exclusively LMIC-affiliated. Representation of LMIC-affiliated first authors were lower in studies based in low-income countries (25.0%) or in sub-Saharan Africa (26.5%), published in journals with higher impact factors (68.0% in Ophthalmology), funded by high-income countries (HICs) (41.4%), or conducted in both LMICs and HICs (27.1%). The United States, United Kingdom, and Australia had the 3rd, 6th, and 8th largest shares of last authors. There were only 12 single-country studies conducted in low-income countries, namely Ethiopia, the Gambia, Guinea, Liberia, the Niger, and Sierra Leone. Of these countries, only three held first authorship and one held last authorship.

CONCLUSIONS

Although LMIC-based ophthalmic research has demonstrated higher local authorship representation compared to other fields, underrepresentation can be exacerbated by country income level, journal "prestige," and degree of HIC involvement. These discrepancies highlight the need for more equitable data ownership in global ophthalmic research.

Methods used to conceptualize dimensions of health equity impacts of public health interventions in systematic reviews

OBJECTIVES

Our aims were to, first, identify and summarize the use of methods, frameworks, and tools as a conceptual basis for investigating dimensions of equity impacts of public health interventions in systematic reviews including an equity focus. These include PROGRESS-Plus, which identifies key sociodemographic characteristics that determine health outcomes. Second, we aimed to document challenges and opportunities encountered in the application of such methods, as reported in systematic reviews.

STUDY DESIGN AND SETTING

We conducted a methodological study, comprising an overview of systematic reviews with a focus on, or that aimed to assess, the equity impacts of public health interventions. We used electronic searches of the Cochrane Database of Systematic Reviews, the Database of Promoting Health Effectiveness Reviews (DoPHER), and the Finding Accessible Inequalities Research in Public Health Database, supplemented with automated searches of the OpenAlex dataset. An active learning algorithm was used to prioritize title-abstract records for manual screening against eligibility criteria. We extracted and analyzed a core dataset from a purposively selected sample of reviews, to summarize key characteristics and approaches to conceptualizing investigations of equity.

RESULTS

We assessed 322 full-text reports for eligibility, from which we included 120 reports of systematic reviews. PROGRESS-Plus was the only formalized framework used to conceptualize dimensions of equity impacts. Most reviews were able to apply their intended methods to at least some degree. Where intended methods were unable to be applied fully, this was usually because primary research studies did not report the necessary information. A general rationale for focusing on equity impacts was often included, but few reviews explicitly justified their focus on (or exclusion of) specific dimensions. In addition to practical challenges such as data not being available, authors highlighted significant measurement and conceptual issues with applying these methods which may impair the ability to investigate and interpret differential impacts within and between studies. These issues included investigating constructs that lack standardized operationalization and measurement, and the complex nature of differential impacts, with dimensions that may interact with one another, as well as with particular temporal, personal, social or geographic contexts.

CONCLUSION

PROGRESS-Plus is the predominant framework used in systematic reviews to conceptualize differential impacts of public health interventions by dimensions of equity. It appears sufficiently broad to encompass dimensions of equity examined in most investigations of this kind. However, PROGRESS-Plus does not necessarily ensure or guide critical thinking about more complex pathways, including interactions between dimensions of equity, and with wider contextual factors, and important practical, measurement and conceptual challenges remain. The findings from investigations of equity impacts in systematic reviews could be made more useful through more explicitly rationalized and considered approaches to the design, conduct and reporting of both primary research and the reviews themselves.

Equity Reporting in Systematic Reviews of Opioid Treatment of Chronic Non-Cancer Pain with Patient-Reported Outcomes

Chronic non-cancer pain can affect a patient's social life, ability to work, and overall quality of life (QoL). Opioid therapy is often prescribed as therapeutic treatment in chronic pain. Systematic reviews (SRs)-the pinnacle of research quality-are often used in guideline development; however, pain may differ across cultures and communities. Thus, examination of equity reporting in such SR is necessary. This study examines reporting using the PROGRESS (Place of resident, Race, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital)-Plus framework to examine equity within SRs with patient reported outcomes of chronic, non-cancer pain. A systematic search for SRs was conducted, which were evaluated for PROGRESS-Plus items and study characteristics were extracted. Among the 46 included SRs, seven did not include any PROGRESS-Plus items. The most commonly reported items were age, included within 34 SRs, followed by gender (30/46), and duration of pain (14/46). All other items were reported in five or less studies. Our investigation revealed a deficiency in SR's reporting of equity measures for opioid treatment of chronic non-cancer pain. Given the need to address healthcare disparities among minorities, implementing the PROGRESS-Plus framework may influence QoL and patient-centered care.

Evidence on cataract in low- and middle-income countries: an updated review of reviews using the evidence gap maps approach

In 2014, Sightsavers developed the first evidence gap map (EGM) to assess the extent and quality of review-level evidence on cataract relevant to low-and middle-income countries. The EGM identified 52 studies across five broad themes. This paper reports the update of the EGM conducted in 2021 and changes to the extent and quality of the evidence base. We updated the EGM using the exact process conducted to develop the original. Searches were run to 14 September 2021, and two independent reviewers selected eligible studies, critically appraised them and extracted data using the Supporting the Use of Research Evidence checklist. A summary quality assessment was shared with the authors for comments. Forty-six new reviews were identified, and the EGM now includes 98 reviews. The new reviews predominantly focus on treatment and risk factors. The overall methodological quality was found to be improved, with 13/46 reporting high confidence in findings. EGMs remain a useful tool for policy-makers to make informed decisions and periodic updates are important to assess changes and to refine the focus for future research. The EGM highlights significant disparity in the topics addressed by reviews, with health system interventions particularly neglected.

Health disparities, COVID-19, and maternal and childbirth outcomes: a meta-epidemiological study of equity reporting in systematic reviews

BACKGROUND

Pregnant women with COVID-19 are at increased risk for adverse maternal and pregnancy outcomes, and birth complications. Given the health outcome disparities among pregnant women of racial and ethnic minorities and the reliance of medical practice on systematic reviews and meta-analyses (SRMAs)-as they are the apical component in the hierarchy of evidence in medical research-the primary objective of the study is to examine the inclusion of the equity reporting in SRMAs focused on pregnancy outcomes and COVID-19 using PROGRESS-Plus equity framework. PROGRESS represents equity measures of Place, Race, Occupation, Gender, Religion, Education, Social capital, and Socio-economic status.

METHODS

We conducted a systematic search of three databases to identify SRMAs related to maternal and pregnancy outcomes related to COVID-19. We extracted whether SRMAs reported or analyzed PROGRESS-Plus components among other study characteristics.

RESULTS

Nearly 85% of SRMAs did not include any equity items to account for racial or geographic disparities. Reporting of race was absent from 95% of the studies. Place was the most common PROGRESS item and maternal age was the most common PROGRESS-Plus item reported overall.

CONCLUSION

When research is performed and reported in a way that fails to address disparities, the downstream repercussions may include medical care in the form of new protocol-driven hospital management, pharmacologic interventions, and other treatment options that mirror this absence in reporting. The absence of adequate reporting widens gaps in health outcomes among at-risk groups, such as pregnant women of racial and ethnic minorities.

Analysis of the Effect of Phacoemulsification and Intraocular Lens Implantation Combined With Trabeculectomy on Cataract and Its Influence on Corneal Endothelium

Objective

This study aimed to discuss the effect of phacoemulsification and intraocular lens implantation (PHACO + IOL) combined with trabeculectomy (TRAB) on cataracts and its influence on the corneal endothelium.

Methods

We selected 120 cataract patients admitted to our hospital from January 2018 to January 2021. According to different surgical methods, they were divided into the control group and the observation group. The observation group was treated with PHACO + IOL combined with TRAB, the control group only received PHACO. The clinical effect, ophthalmic-related parameters, corneal endothelium, complications, the satisfaction of the two groups were observed.

Results

The total effective rate and total satisfaction rate of the observation group were significantly higher than the control group (P < 0.05). One month after the operation, the vision and central anterior chamber depth of the observation group were higher than those of the control group, and intraocular pressure (IOP) was lower than that of the control group (P < 0.05). One month after the operation, the corneal endothelial cell area and cell density in the observation group were not significantly different from those before operation (P > 0.05). There was no significant difference in the total incidence of complications between the two groups (P > 0.05).

Conclusion

This study concluded that PHACO + IOL combined with TRAB has a good curative effect in the treatment of cataracts, which can improve the patients' vision and IOP, keep the functional integrity of corneal endothelial cells, and does not increase the occurrence of complications, the patients' satisfaction is high.

How effects on health equity are assessed in systematic reviews of interventions

BACKGROUND

Enhancing health equity is endorsed in the Sustainable Development Goals. The failure of systematic reviews to consider potential differences in effects across equity factors is cited by decision-makers as a limitation to their ability to inform policy and program decisions.  OBJECTIVES: To explore what methods systematic reviewers use to consider health equity in systematic reviews of effectiveness.

SEARCH METHODS

We searched the following databases up to 26 February 2021: MEDLINE, PsycINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Hein Index to Foreign Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on 10 June 10 2021. We contacted authors and searched the reference lists of included studies to identify additional potentially relevant studies.

SELECTION CRITERIA

We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. We define health inequalities as unfair and avoidable differences across socially stratifying factors that limit opportunities for health. We operationalised this by assessing studies which evaluated differences in health across any component of the PROGRESS-Plus acronym, which stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social capital. "Plus" stands for other factors associated with discrimination, exclusion, marginalisation or vulnerability such as personal characteristics (e.g. age, disability), relationships that limit opportunities for health (e.g. children in a household with parents who smoke) or environmental situations which provide limited control of opportunities for health (e.g. school food environment).

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data using a pre-tested form. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews.  MAIN RESULTS: In total, 48,814 studies were identified and the titles and abstracts were screened in duplicate. In this updated review, we identified an additional 124 methodological studies published in the 10 years since the first version of this review, which included 34 studies. Thus, 158 methodological studies met our criteria for inclusion. The methods used by these studies focused on evidence relevant to populations experiencing health inequity (108 out of 158 studies), assess subgroup analysis across PROGRESS-Plus (26 out of 158 studies), assess analysis of a gradient in effect across PROGRESS-Plus (2 out of 158 studies) or use a combination of subgroup analysis and focused approaches (20 out of 158 studies). The most common PROGRESS-Plus factors assessed were age (43 studies), socioeconomic status in 35 studies, low- and middle-income countries in 24 studies, gender or sex in 22 studies, race or ethnicity in 17 studies, and four studies assessed multiple factors across which health inequity may exist. Only 16 studies provided a definition of health inequity. Five methodological approaches to consider health equity in systematic reviews of effectiveness were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (140 of 158 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (50 studies); 3) analytic approaches which assessed differential effects across one or more PROGRESS-Plus factors (16 studies); 4) applicability assessment (25 studies) and 5) stakeholder engagement (28 studies), which is a new finding in this update and examines the appraisal of whether relevant stakeholders with lived experience of health inequity were included in the design of systematic reviews or design and delivery of interventions. Reporting for both approaches (analytic and applicability) lacked transparency and was insufficiently detailed to enable the assessment of credibility.

AUTHORS' CONCLUSIONS

There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to consider health equity in systematic reviews of effectiveness.

Identifying priority review questions for Cochrane Eyes and Vision: protocol for a priority setting exercise

INTRODUCTION

Cochrane Eyes and Vision (CEV) is an international network of individuals working to prepare, maintain and promote access to systematic reviews of interventions to treat, prevent or diagnose eye diseases or vision impairment. CEV plans to undertake a priority setting exercise to identify systematically research questions relevant to our scope, and to formally incorporate input from a wide range of stakeholders to set priorities for new and updated reviews.

METHODS AND ANALYSIS

The scope of CEV is broad and our reviews include conditions that are common and have a high global disease burden, for example, cataract and dry eye disease, and conditions that are rare but have a high impact on quality of life and high individual cost such as eye cancer. We plan to focus on conditions prioritised by WHO during the development of the Package of Eye Care Interventions. These conditions were selected based on a combination of data on disease magnitude, healthcare use and expert opinion. We will identify priority review questions systematically by summarising relevant data on research in Eyes and Vision from a range of sources, and compiling a list of 10-15 potential review questions (new and/or updates) for each condition group. We will seek the views of external and internal stakeholders on this list by conducting an online survey. Equity will be a specific consideration.

ETHICS AND DISSEMINATION

The study has been approved by the ethics committee of the London School of Hygiene & Tropical Medicine. We will disseminate the findings through Cochrane channels and prepare a summary of the work for publication in a peer-reviewed journal.

The Association between Post-Migration Nutrition and Lifestyle Transition and the Risk of Developing Chronic Diseases among Sub-Saharan African Migrants: A Mixed Method Systematic Review Protocol

Sub-Saharan African (SSA) migrants face nutrition and lifestyle changes upon arrival in a host country. The shift in diet and lifestyle reflects post-migration acculturation and could predispose migrants to nutrition- and lifestyle- related chronic diseases. A mixed-methods systematic review of published studies and the grey literature on post-migration nutrition and lifestyle transition among SSA migrants will be undertaken. Studies published in English and conducted from 2000 to 2020 using quantitative and/or qualitative methods will be included. Ten bibliographic databases will be searched: Scopus, Ovid MEDLINE, EMBASE, Global Health, CINAHL, PubMed, ProQuest, PsycINFO, Informit and Web of Science. Data extraction will be informed by the Cochrane PROGRESS-Plus framework and the Joanna Briggs Institute manual. The quality of the included studies will be appraised for risk of bias using validated tools. An integrated approach to quantitative and qualitative data synthesis through data transformation will be undertaken, and a narrative synthesis of the findings will be provided. This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and provides insight into the scope and parameters of the systematic review to be conducted. The aim of the review is to evaluate the association between post-migration nutrition and lifestyle transition and the risk of developing chronic diseases among SSA migrants in Australia. This review will provide insight into possible areas for interventions to improve the health of migrants. Systematic Review Registration: The protocol was registered with the PROSPERO international prospective register of systematic reviews CRD42020206560.

Authorship diversity among systematic reviews in eyes and vision

IMPORTANCE

The inclusion of authors from diverse backgrounds and with different lived experiences is critical to ensuring the questions addressed in systematic reviews (SRs), as well as the subsequent conclusions and recommendations made, are representative of the global community.

OBJECTIVE

To assess the gender and geographic diversity of authors among all Cochrane SRs in eyes and vision as compared with a random sample of non-Cochrane SRs of interventions in the field of eyes and vision.

DESIGN

The Cochrane Eyes and Vision US Satellite maintains a database of SRs in the field of eyes and vision. We selected all (n = 313) eyes and vision intervention SRs published in The Cochrane Library and a random sample of 313 eyes and vision intervention SRs published elsewhere for this study. We determined gender of the first and corresponding authors ("woman," "man," or "unknown") using a previously developed algorithm and their location based on institution country and the World Health Organization region.

RESULTS

From the 626 reviews included in our sample, we identified 751 unique authors who comprised 887 author positions (i.e., first and/or corresponding authors). We were able to ascertain the gender of 647/751 (86%) authors: 276 women and 371 men. Among Cochrane eyes and vision SRs, the proportions of women in first and/or corresponding author positions were consistent and approximately equal to men. Among non-Cochrane eyes and vision SRs, the representation of women was markedly lower as corresponding authors than other positions. Most authors of Cochrane eyes and vision SRs were from the UK (31%) and USA (26%), whereas most authors of non-Cochrane SRs were from China (34%).

CONCLUSIONS AND RELEVANCE

Compared with authors of non-Cochrane SRs in eyes and vision, authors of Cochrane SRs appear to have approximately equal representation of women and men among perceived important author positions and be located in European and North American countries, possibly due to the locations of the Cochrane editorial teams. Cochrane Eyes and Vision should continue to recruit authors from around the world in locations that reflect the global burden of eye disease.