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Editors Selection IGR 25-4

Miscellaneous: Too many glaucoma trials never make it to publication

Comment by Carla Siegfried & Sharon Sabapathypillai on:

125039 Publication Rates and Patterns of Registered Glaucoma Trials, Meller LLT; Meller LLT; Kashaf MS; Sambo A et al., Ophthalmology, 2025; 132: 1054-1061

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Peer-reviewed publication of results of glaucoma clinical trials is a requisite for development of high-quality evidence to guide patient care. Unfortunately, publication bias may impact our body of scientific literature with significant consequences on our conclusions about the efficacy of an intervention. This cross-sectional analysis by Meller et al assesses publication rates and patterns of glaucoma trials registered in ClinicalTrials.gov, highlighting deficiencies in dissemination of results. Utilizing published methods of a similar evaluation of cornea studies,1 incomplete reporting is pervasive among 969 glaucoma trials identified with limited search terms with only 53% published, and 32% provided results on ClinicalTrials.gov.

The authors performed important comparisons including industry sponsorship, interventional vs observational, intervention modality type, and phase level. Prior studies of publication rates in other ophthalmology subspecialties demonstrated similar results of low publication rates (52-59%),2,3 excluding one study with contrasting methods. Industry-sponsored glaucoma trials were more likely to be interventional, completed earlier, but only 23% were published within 2 years of study completion and 30% within 3 years, the duration limit of this study. This finding may suggest that industry financial support and focus on outcomes to provide basis for an intervention may be a factor for earlier trial completion, but with reduced publication rates and potential bias to avoid publication of negative results.

The establishment of ClinicalTrials.gov to address publication bias and timely dissemination of results within the FDA-mandated timeframe of 2 years (mean delay of 34 months) has clearly not been completely successful. In addition, international trials, which are less likely to be registered on ClinicalTrials.gov, were more likely to be published. This disparity is disconcerting and not consistent with goals of global health promotion requiring further assessment, potentially including these metrics by grant funding organizations, as suggested by the authors. In summary, this paper may help improve patient care by bringing awareness to the importance of timely reporting of results, both positive and negative, to improve our advancement of evidence-based glaucoma care.

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