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Out of 87 reviews reporting assessment of MQ/ROB, only 12.64\% (11/87) explicitly stated that low MQ/high ROB were excluded from their review while 57.47\% (50/87) included articles with low MQ/high ROB. More than twice as many studies were unclear about inclusion of low MQ/high ROB (29.89\%; 26/87) as those that were excluded (12.64\%; 11/87). Of the 50 articles that included articles with low MQ/high, only 42.0\% (21/50) performed a subgroup analysis, 32.0\% (16/67) conducted a meta-regression analysis, and 62.0\% (31/50) performed a sensitivity analysis. The quintessential systematic review would exclude all primary studies that contained low MQ/high ROB. Yet, in the least, a review should perform a subgroup, meta-regression, or sensitivity analysis to account for the possible affect that inclusion may have on summary effect size (Katikireddi 2015).  In conclusion, our study has suggested that most authors in ophthalmology rarely assess MQ/ROB in their systematic reviews. Moreover, when MQ/ROB is evaluated, the majority of authors use a tool that does not provide an accurate assessment of study validity. The implications of these conclusions provide that many therapeutic interventions in ophthalmology are founded on systematic reviews that may be  composed of unsound evidence, thus resulting in unwarranted treatment.  We recommend that systematic reviewers adopt the use of the Cochrane Risk of Bias Tool for the evaluation of MQ/ROB due to the well-founded indication that other scales, custom measures, and checklists provide an invalid assessment of quality and risk of bias. Future research could examine the relationship between what determines  the authors’ choice of MQ/ROB tools and extent to which in systematic reviews. A thorough review of studies that contain custom measures may be warranted, as  these tools evaluate MQ/ROB. custom measures may have no basis in the evalutation of quality or risk of bias, and, alternatively, may only inflate MQ/ROB scores.