This systematic review and meta-analysis examined whether the transparency of conflict of interest (COI) declarations is associated with study outcomes, statistical conclusions, and methodological quality across 134 RCTs of myopia control interventions in children and adolescents, with ≥6 months of follow-up and reporting cycloplegic spherical equivalent and/or axial length outcomes (search inception to October 6, 2025).
Only 14.2% of trials provided detailed COI statements; more detailed disclosures correlated with lower risk of bias and better selective outcome reporting (both P<0.01). In stratified analysis, greater COI transparency was linked to more favorable conclusions in optical intervention trials (OR = 2.66, 95% CI: 1.19–5.92, P=0.02), an association that persisted after adjusting for industry funding.
Cross-sectional design limits causal inference between COI transparency and outcomes. COI transparency was categorized using predefined levels that may not capture all nuances of disclosure. Associations in subgroups (larger trials, higher-impact journals) were attenuated after accounting for industry funding, suggesting residual confounding.
When evaluating myopia control RCT evidence, clinicians should assess both the level of COI detail and the funding source together — detailed disclosure alone does not guarantee unbiased results. Nearly 12% of trials reported no COI statement at all, flagging a gap in research transparency that should prompt scrutiny.
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