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After investigating the specific appraisal instruments as well as the particular components included in MQ/ROB evaluations, we wanted to examine how primary studies receiving low quality or high/unclear risk of bias determinations were incorporated into systematic review outcomes (Table 4). From journals with more than five systematic reviews included in our sample, those published in The British Journal of Ophthalmology included low MQ/high ROB primary studies in the estimation of summary effect sizes more often than any other (15/22; 68.18\%); however, subgroup analysis, meta-regression, and sensitivity analysis were conducted the least often in this same journal with only 18.18\% (4/22), 13.64\% (3/22), and 36.16\% (8/22) of their reviews performing these analyses, respectively. Ophthalmology followed with 58.70\% (27/46) of low MQ/high ROB studies included in their reviews. effect size calculations. Systematic reviews published in  Investigative Ophthalmology and Visual Science excluded the largest percentage of low MQ/high ROB  studies from producing summary effects  (50.0\%; 3/6), and also conducted subgroup (33.33\%; 2/6), meta-regression (33.33\%; 2/6), and sensitivity analyses (66.67\%; 4/6) the most frequently. The British Journal of Ophthalmology (13.64\%; 3/22), JAMA ophthalmology (20.0\%; 1/5), and the American Journal of Ophthalmology (14.29\%; 1/7) all excluded a higher percentage of primary studies in their systematic reviews than the average percentage (12.64\%; 11/87) excluded across all journals. In more than 1/3 of their reviews, The American Journal of Ophthalmology (57.14\%; 4/7) and Ophthalmology (34.78\%; 16/46) had unclear statements on whether low MQ/high ROB were included. Sensitivity analysis was the performed most often in all journals (35.63\%; 31/87) while meta-regression was carried out the least (18.39\%; 16/87).