EQUATOR reporting guideline use and editorial enforcement in four medical specialties: a cross-sectional study of 20 high-impact journals

Background EQUATOR (Enhancing the QUAlity and Transparency Of Health Research) reporting guidelines aim to improve transparency and completeness in biomedical research; however, their adoption remains inconsistent across medical specialties. We quantified declared reporting guideline use in high-impact ophthalmology journals and assessed whether editorial policies are associated with their implementation across specialties. Methods We conducted a cross-sectional study of original research articles published in 2024 across five first-quartile ophthalmology journals. Reporting guideline use was identified through systematic full-text searches. An “advisable use rate” was defined as the proportion of articles declaring guideline use among those for which use was methodologically appropriate. Journal enforcement policies were characterized through analysis of instructions for authors. Guideline use in ophthalmology was contextualized through comparison with previously published datasets from orthopedics, rheumatology, and infectious diseases. Results Among 794 original research articles, reporting guidelines were deemed advisable for 672 (84.6%). Of these, 192 articles (28.6%) declared guideline use. Advisable use rates ranged from 5% to 120% across journals. STROBE was the most frequently applicable guideline but was declared in only 27% of eligible articles. Ophthalmology guideline use exceeded orthopedics (10.2%), rheumatology (7.2%), and infectious diseases (6.3%). Although enforcement policies varied across journals, no significant correlation was observed between enforcement level and guideline use (Kendall’s τ = 0.24, p > 0.05). Conclusions Despite higher adoption relative to other specialties, reporting guideline use in ophthalmology remains limited. Substantial inter-journal variability and the absence of an association between enforcement policies and use highlight opportunities to better align editorial expectations with reporting practices.