Principles of good research for

eye health
Clare Gilbert

iceh.lshtm.ac.uk/
 Inverse-research law
• ~90% of people with vision impairment live in low- and middle- income countries
• Only 30% of published research was undertaken in these regions
1%
5%
11%

Central/East Europe, Central Asia

High-income
4% Location of primary
Latin America and Caribbean 6% research 2000-2019
North Africa and Middle East
South Asia 2%
Southeast Asia, East Asia, Oceania
Sub-Saharan Africa
70%

Ramke et al. Lancet Commission on Global Eye Health, Supplement

 Hierarchy of scientific evidence

Synthesis 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

By 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=93799763
Principles of good research (for eye health)
Purpose
• To fill gaps in our knowledge by providing evidence that we can trust, use in decision
making and build on
• Without evidence decisions tend to be based on
• Experience – our own or other people’s
• Eminence – 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 biased
• Local research, which addresses local needs and knowledge gaps, is essential
Where to start….
o Identify the problem/knowledge gap you want to address
o Decide who are you going to work with; more brains are always better than one!
o What have other researchers done and found? Find and read other studies
o Time spent on detailed, logical planning is very important: once data have been
collected it is usually too late to make changes
o Everything always takes longer than anticipated…….
o 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)
Planning a study
Detailed, logical planning is critical to success….
• Have an open mind about what you might find
• Use your imagination
• Think about assumptions you may have
• Beware of bias, which can lead to results which are difficult to
interpret
• A study with too few participants may not give valid results; too many
participants is a waste of their/your time and resources
Where to start…
Write down a good research question which addresses the gap identified
• Clear, specific, concise

Problem: Patients with open angle glaucoma are coming back blind because they have not
attended follow up
Question: 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
outcomes
Question: Why do children with bilateral congenital cataract present after the age of two years to
the eye department?
Problem: The waiting list for adult cataract surgery has grown to one year
Question: 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?
 Planning an observational study

Aim and obje ctive s

- Aim: how the da ta collected will Me thods
Proble m / e vide nce Re s e arch que s tion Decide methods for ea ch objective
a ddres s the problem identified
gap to be Clea r, s pecific a nd - qua ntita tive methods : numbers
- Objectives : s pecific a ctivities
addre s s e d concis e - qua lita tive methods : na rra tive text
which need to be underta ken to
a ns wer the res ea rch ques tion - mix of the a bove
 Planning an observational study

De cide data to be colle cte d

Study participants De ve lop and pilot te s t data
- extra ct da ta from
- pa tients / fa mily colle ction me thods Sample s ize
medica l/ s urgica l records
members - ques tionnna ires for Decide how ma ny
- ques tionnna ires for qua ntita tive
- community members qua ntita tive da ta pa rticipa nts a re needed
da ta
- eye hea lth profes s iona ls - interviews guides with to give relia ble res ults
- interviews guides with ques tions
- more tha n one group ques tions to a s k
to a s k for qua lita tive da ta
 Planning an observational study

Data analys is Plan the logis tics Plan dis s e mination of Ethical approval
Decide how the da ta a re Timefra me; s ta ff tra ining; re s ults Budge t Not a ll s tudies need
going to be a na lys ed where da ta will be Pres enta tions , Bes t to do this once the ethica l a pprova l; s eek
Different methods a re collected a nd how (pa per; publica tions , reports ; methods a nd logis tics a dvice from a n ethics
needed for qua ntita tive electronic; a udio feedba ck to pa rticipa nts ha ve been worked out committee if you a re not
a nd qua lita tive methods recordings ) etc etc s ure
 What next?
• Identify people with the relevant expertise (e.g., qualitative research,
statistics) and get their input
• Make revisions
• Seek an independent opinion from an experienced researcher
• Listen to what they say
• Revise the research plan (“protocol”)
 Planning an observational study

Data analys is Plan the logis tics Plan dis s e mination of Ethical approval
Decide how the da ta a re Timefra me; s ta ff tra ining; re s ults Budge t Not a ll s tudies need
going to be a na lys ed where da ta will be Pres enta tions , Bes t to do this once the ethica l a pprova l; s eek
Different methods a re collected a nd how (pa per; publica tions , reports ; methods a nd logis tics a dvice from a n ethics
needed for qua ntita tive electronic; a udio feedba ck to pa rticipa nts ha ve been worked out committee if you a re not
a nd qua lita tive methods recordings ) etc etc s ure
 Implementing an observational study

Unde rtaking the s tudy
Da ta collection m us t be
rigorous a nd of high qua lity.
Needs good da ta collection
intrum ents ; well tra ined s ta ff;
s upervis ion; m onitoring of
com pletenes s a nd a ccura cy of
da ta collection etc
Che cking and analys ing the
data
Check com pletenes s of da ta ,
a nd follow the pla n for a na lys is
(qua ntia tive a nd qua lita tive).
Ma y need to report progres s to
the ethics com m ittee.
Inte rpre t the findings
To wha t extent ha s the
res ea rch ques tion been
a ns wered? Wha t a re the Dis s e minate the findings
im plica tions of the findings ? according to the plans
Wha t a re the lim ita tions of the
s tudy (a ll s tudies ha ve
lim ita tions !)?
No research is perfect…..
• But there are poorer or better ways of conducting studies
• Some studies can be “fatally flawed” which means they cannot be published e.g.,
major omission in the data collected; lack of a comparison group
• It 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