Clare Gilbert Inverseresearch law 90 of people with vision impairment live in low and middle income countries Only 30 of published research was undertaken in these regions Location of p rimary research 20002019 ID: 1047401
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1. Principles of good research for eye healthClare Gilbert
2. Inverse-research law~90% of people with vision impairment live in low- and middle- income countriesOnly 30% of published research was undertaken in these regionsLocation of primary research 2000-2019Ramke et al. Lancet Commission on Global Eye Health, Supplement
3. Hierarchy of scientific evidenceBy The Logic Of Science - https://thelogicofscience.files.wordpress.com/2016/04/hierarchy-of-evidence-no-not1.png, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=93799763Synthesis of data from all randomized controlled trials/studies a addressing the same topic Gold standard for assessing a new drug / surgical technique Incidence and risk factors for a condition Risk factors for a condition Surveys: prevalence (and risk factors) for a condition
4. Principles of good research (for eye health)PurposeTo fill gaps in our knowledge by providing evidence that we can trust, use in decision making and build onWithout evidence decisions tend to be based on Experience – our own or other people’sEminence – what the boss says!Eloquence – persuasive arguments Expectations – of patients, their families or health care workers…all of the above are subjective, and are likely to be biasedLocal research, which addresses local needs and knowledge gaps, is essential
5. Where to start….Identify the problem/knowledge gap you want to addressDecide who are you going to work with; more brains are always better than one!What have other researchers done and found? Find and read other studiesTime spent on detailed, logical planning is very important: once data have been collected it is usually too late to make changesEverything always takes longer than anticipated…….Observational / descriptive studies are more straightforward than studies which assess an intervention (a new way of doing something, which may be context specific - a new screening or diagnostic test; a new surgical technique or medication)
6. Planning a studyDetailed, logical planning is critical to success….Have an open mind about what you might findUse your imaginationThink about assumptions you may haveBeware of bias, which can lead to results which are difficult to interpretA study with too few participants may not give valid results; too many participants is a waste of their/your time and resources
7. Where to start…Write down a good research question which addresses the gap identifiedClear, specific, concise Problem: Patients with open angle glaucoma are coming back blind because they have not attended follow upQuestion: What proportion of patients with open angle glaucoma drop out of regular follow up after diagnosis, and which patients are less likely to attend regularly?Problem: Children with congenital cataract are presenting too old for management to give good outcomesQuestion: Why do children with bilateral congenital cataract present after the age of two years to the eye department?
8. Problem: The waiting list for adult cataract surgery has grown to one yearQuestion: What are the provider and patient factors which lead to the long waiting list? Problem: During outreach most of the cataract blind individuals are elderly women Question: What factors prevent elderly cataract-blind women from attending for cataract surgery, and what are they willing to pay for surgery?Problem: Many glaucoma patients say they have difficulty putting in their eye drops.Question: What is the best way to teach patients how to put in their eye drops?
9. Planning an observational study
10. Planning an observational study
11. Planning an observational study
12. What next?Identify people with the relevant expertise (e.g., qualitative research, statistics) and get their inputMake revisionsSeek an independent opinion from an experienced researcherListen to what they sayRevise the research plan (“protocol”)
13. Planning an observational study
14. Implementing an observational study
15. No research is perfect…..But there are poorer or better ways of conducting studiesSome studies can be “fatally flawed” which means they cannot be published e.g., major omission in the data collected; lack of a comparison groupIt is much better to seek advice early rather than waiting until all the data have been collected before asking someone to help with the analysis or writing up