To determine how well microinvasive glaucoma surgical (MIGS) trials conform to the World Glaucoma Association (WGA) guidelines. Lack of well-designed MIGS studies hinders meaningful evaluation of these technologies.
Cross-sectional literature survey.
Using a predefined search strategy, the following databases were searched for comparative trials involving MIGS in the English peer-reviewed literature from January 1, 2000, through June 21, 2018: Medline, EMBASE, BIOSIS, Cochrane, and Web of Science. From the WGA guidelines, 53 outcomes were selected for evaluation: methodology (n = 31), definition of success (n = 7), ethics (n = 10), postoperative complications (n = 1), economic evaluation (n = 1), and statistical reporting (n = 3). Each article was assessed by 2 reviewers; differences were resolved by consensus.
Twenty-five eligible publications were identified: 10 randomized controlled trials (RCTs) and 15 nonrandomized comparative trials (non-RCTs). The mean follow-up was 19.9±11.6 months (range, 6-48 months). The mean number of outcomes adhering to the WGA guidelines of the 53 evaluated was 24.2±6.1 (45.6% compliance): 28.0±6.2 (52.8%) and 21.6±4.7 (40.8%) for RCTs and non-RCTs, respectively (P = 0.01). Mean percent compliance for each subsection were: methodology, 48.8%; definition of success, 21.1%; ethics, 55.6%; postoperative complications, 88%; economic evaluation, 0%; and statistical reporting, 37.3%. In 16 studies (64%), at least 1 author reported an association with the industry. Thirty-two percent of studies reported an author being a shareholder. Twenty-four percent of studies had an industry employee author. The primary intraocular pressure (IOP) end point was defined as both an upper limit and percentage reduction in only 4 studies (16%; 1 RCT, 3 non-RCTs). An IOP-based survival curve was provided in 7 studies (28%; none of the RCTs). Two studies (8%) included an IOP scatterplot. Twelve studies (48%) reported 95% confidence intervals. Only 4 studies (16%) used the mean of 3 diurnal IOP readings as the baseline IOP.
Published comparative MIGS trials show low adherence (45.6%) to the WGA guidelines. Development of standardized methodology and outcomes could enhance interpretation and transparency of study results and facilitate comparisons between trials. Authors and journals should be encouraged to follow the WGA guidelines.

OBJECTIVE: To report the results of a Latin American consensus panel regarding the diagnosis and management of primary open-angle glaucoma and to compare these results with those from a similar panel in the United States.
METHODS: A RAND-like (Research and Development) appropriateness methodology was used to assess glaucoma practice in Latin America.
METHODS: The 148 polling statements created for the RAND- like analysis in the United States and 10 additional statements specific to glaucoma care in Latin America were presented to a panel of Latin American glaucoma experts. Panelists were polled in private using the RAND- like methodology before and after the panel meeting.
RESULTS: Consensus agreement or disagreement among Latin American experts was reached for 51.3% of statements before the meeting and increased to 66.5% in the private, anonymous meeting after polling (79.0% agreement, 21.0% disagreement). Although there was a high degree of concordance (111 of 148 statements; 75%) between the results of this Latin American panel and the United States panel, there were some notable exceptions relating to diagnostic and therapeutic decision making.
CONCLUSIONS: This RAND-like consensus methodology provides a perspective of how Latin American glaucoma practitioners view many aspects of glaucoma and compares these results with those obtained using a similar methodology from practitioners in the United States. These findings may be helpful to ophthalmologists providing glaucoma care in Latin America and in other regions of the world.

OBJECTIVE: To present the results of a panel consensus assessment of evaluation and therapy relating to primary open-angle glaucoma based on available evidence and expert opinion.
METHODS: A panel consensus assessment of glaucoma diagnosis and therapy using a modified RAND-like appropriateness methodology.
METHODS: One hundred and forty-eight questions, most of which related to glaucoma therapy, were created by a core nonvoting executive committee based on common clinical questions. An evidence-based review of the literature pertaining to these questions was provided to 10 voting panelists. These panelists, who did not participate in either the creation of the questions or the conduct of the literature review, then were polled using a modified technique derived from existing methodology.
RESULTS: Consensus agreement or disagreement was reached for 55.4% and 74.3% of the polling statements before and after the panel meeting, respectively. This represents a consensus agreement or disagreement on a majority of polling statements both before and after a meeting of all panelists and the two co-chairs of the program. There was an increase in the proportion of statements where consensus agreement was reached after the panel meeting.
CONCLUSIONS: Given the paucity of high-quality evidence relating to many of the issues addressed in this assessment and the variability of practice patterns among ophthalmologists, consensus agreement or disagreement was reached for a high proportion of polling statements.