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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 other than the Cochrane Risk 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 composed  ofBias Tool.  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 the reviewers’ authors’  choice of MQ/ROB tools and extent to which these tools evaluate MQ/ROB.    
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