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\textbf{Discussion}  The broad influence that systematic reviews of randomized controlled trials have on clinical decision-making proves how crucial these types of studies are for patient treatment. Health care providers use the information gained systematic reviews to attempt to give their patients the best treatment possible. Nonetheless, when the original studies that constitute these systematic reviews have foundational errors in study design they can be put at high risk of bias, which, as a result, decreases the overall benefit gained from systematic reviews (Katikireddi 2015). In our examination of ophthalmology journals, only 47.80\% (87/182) of reviews reported the assessment of MQ/ROB. Out of all 182 reviews included in our study, only 10.44\% (19/182) explicitly stated that low MQ/high ROB were excluded from their review while 36.81\% (67/182) included articles with low MQ/high ROB. Nearly as many studies were unclear about inclusion of low MQ/high ROB 11.54\% (21/182) as those that were excluded. Of the 67 articles with low MQ/high, only 31.34\% (21/67) performed a subgroup analysis, 23.88\% (16/67) included a meta-regression analysis, and 46.27\% (31/67) performed a sensitivity analysis. These analyses usually account for the low MQ/high ROB included in these reviews, but each was left out of more than half of the studies including low MQ/high ROB.   Moreover, there is extensive disagreement over which MQ/ROB tool or checklist is the most effective, if effective at all, at giving the most accurate portrayal of a study’s quality (Zeng 2015) (Jüni 1999). To assess the effectiveness of each scale and tool, we examined each component to evaluate which provides the most of extensive evaluation of MQ/ROB. The Downs and Black Checklist was the most extensive, assessing 62.79\% (27/43) of listed measures. The CASP Checklist for RTCs and the Newcastle-Ottawa scale followed, both assessing 34.88\% (15/43) of measures. QUADAS-2 (32.56\%; 14/43) was slightly more thorough than that QUADAS (30.23\%; 13/43) at assessing MQ/ROB. We found that Jadad (27.91\%; 12/43), the Delphi List (18.60\%; 8/43), and the Cochrane Risk of Bias Tool (16.28\%; 7/43) were the three least extensive of the tools used. In our study we found that the Cochrane Risk of Bias Tool was used most commonly for evaluating MQ/ROB at 22.99\% (20/87) followed by Jadad (20.69\%; 17/87), both of which evaluate two of the least amount of quality measure. The Delphi List, the measure described by Sanderson et al, and QUADAS were each used 5 times (5.75\%) accounting for a total of 17.25\% of MQ/ROB measures. The most extensive MQ/ROB tools (Downs and Black, CASP, QUADAS-2, CASP for RCTs, and the Newcastle-Ottawa scale) were each used the least. 
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