Conflicts of Interest Transparency, Study Outcomes, and Risk of Bias in Myopia Controlled Trials: A Systematic Review and Meta-Analysis
In brief
Detailed conflict disclosures double odds of favorable conclusions in optical myopia trials
In a review of 134 myopia-control RCTs, trials that provided detailed conflict-of-interest statements were more likely to receive low risk-of-bias ratings and, for optical interventions, were about twice as likely to report positive study conclusions. Overall COI transparency did not affect measured treatment effects, highlighting the need to consider funding context when interpreting results.
- Journal
- American journal of ophthalmology (Q1)
- Published
- 14 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Jia-Yan Kai, Ming-Yan Jin, Yue Peng, Dan-Lin Li, Xing-Xuan Dong, Carla Lanca, et al.
- PMID
- 42600884
- DOI
- 10.1016/j.ajo.2026.08.019
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 16 August 2026): COI transparency in myopia RCTs
Abstract
TOPIC: To determine whether the transparency of conflicts of interest (COI) declarations is associated with study outcomes and methodological quality in randomized controlled trials (RCTs) of myopia controlled interventions. CLINICAL RELEVANCE: Myopia control practice is guided largely by RCT evidence, much of which involves industry participation. Variability in the transparency of conflicts of interest disclosures may influence how such evidence is interpreted for clinical decision-making. METHODS: PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from inception to October 6, 2025. Eligible studies were RCTs of myopia controlled interventions in children or adolescents with at least 6 months of follow-up and reporting cycloplegic spherical equivalent (SE) and/or axial length (AL) outcomes. COI declaration transparency was categorized a priori into predefined levels. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Associations between COI transparency and study conclusions, statistical significance, and effect sizes were evaluated using cross-sectional, multiple meta-regression models. The protocol was registered in PROSPERO (CRD420261291949). RESULTS: A total of 134 RCTs were included. Sixteen trials (11.9%) did not report a COI statement, 85 (63.4%) provided simple declarations of no conflicts, 14 (10.4%) reported intermediate disclosures, and 19 (14.2%) provided detailed COI statements. Distributions of overall risk of bias and the domain of selective outcome reporting differed significantly across COI transparency categories, with a higher proportion of low-risk judgments observed in trials with more detailed COI disclosures (both P<0.01). Overall, COI transparency was not significantly associated with study outcomes. However, in stratified analyses, greater COI transparency was significantly associated with more favorable study conclusions among trials evaluating optical interventions, even after adjustment for industry funding and other covariates (OR = 2.66, 95% CI: 1.19 to 5.92, P=0.02). Similar patterns were observed in trials with larger sample sizes and those published in higher-impact factor journals, although these associations were attenuated after accounting for industry funding. CONCLUSION: Transparency in COI declarations demonstrates context-specific relationships with study conclusions and reporting quality in myopia controlled trials. While transparent disclosure is essential for research integrity, its interpretation should be integrated with funding context when evaluating evidence to inform clinical practice.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.