deletions | additions       diff --git a/textbf_Introduction_In_order_for__.tex b/textbf_Introduction_In_order_for__.tex  index abbcaa7..76b726c 100644  --- a/textbf_Introduction_In_order_for__.tex  +++ b/textbf_Introduction_In_order_for__.tex 
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Over the years, researchers have conceived many methods in attempt to evaluate the validity or methodological quality of primary studies. Initially, checklists and scales were developed to evaluate whether particular aspects of experimental design, such as randomization, blinding, or allocation concealment were incorporated into the study. These approaches have been criticized for falsely elevating quality scores. Many of these scales and checklists include items that have no bearing on the validity of study findings, such as whether investigators used informed consent or whether ethical approval was obtained \cite{7743790}. Furthermore, with the proliferation of quality appraisal scales, it was found that the choice of scale could alter the results of systematic reviews due to weighting differences of scale components \cite{10493204}. Two such scales, the Jadad scale - also called the Oxford Scoring System \cite{8721797} and the Downs and Black checklist \cite{9764259} were among the popular alternatives. Quality of Reporting of Meta-analyses (QUORUM) \cite{Moher_1999}, the dominant reporting guidelines at that time, called for the evaluation of methodological quality of the primary studies in systematic reviews. This recommendation was short lived as the Cochrane Collaboration began to advocate for a new approach to assess the validity of primary studies. This new method assessed the risk of bias of 6 particular design features of primary studies, with each domain receiving a rating of either low, unclear, or high risk of bias \cite{higgins2008cochrane}. Following suit, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) - updated reporting guidelines, now calls for the evaluation of bias in all systematic reviews \cite{19622511}.   A previous review examining primary studies from multiple fields of medicine revealed that the failure to incorporate an assessment of methodological quality can result in the implementation of interventions founded on misleading evidence \cite{588948720011204}. Yet, questions remain regarding their use the assessment of quality and risk of bias  in clinical specialties. Therefore, we examined ophthalmology systematic reviews to determine the degree to which methodological quality and risk of bias assessments were conducted. We also evaluated the particular method used in the evaluation, the quality components comprising these assessments, and how systematic reviewers integrated primary studies with low quality or high risk of bias into their results.  
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