Evidence-based medicine is all-important these days. If the British Journal of Ophthalmology is anything to go by, ophthalmologists can hold their heads pretty high: a study published last December showed that an impressive 77% of 274 consecutive interventions in the Hong Kong Eye Hospital were evidence-based – a figure that compares well with other fields of medicine. But there is a deeper malaise, not just in ophthalmology but also across medicine in general – the quality of the evidence base. Responsible clinicians may strive to follow it, but is it any good?