Abstract
Purpose:
To evaluate the content quality, accuracy, and readability of commonly visited websites by cataract patients contemplating cataract surgery.
Setting:
Freely available online information.
Design:
Cross-sectional study.
Methods:
Ten websites were evaluated in a cross-sectional study for content analysis using a grading sheet of 40 questions individually scored by three ophthalmologists. JAMA benchmarks were used to assess the quality. An online readability tool, Readable, was used to assess the readability.
Results:
There was a significant difference between the content and accuracy of each website according to a Kruskal-Wallis test (H=22.623, P=0.007). The average score for all websites using the grading sheet was 90.85 out of 160 points, or 57% (SD 29.93, CI 95%±17.69). There was no significant correlation between website rank on Google.com and content quality of the website (r=0.049, P=0.894). No websites complied with all 4 JAMA criteria for authorship. There was no significant correlation between content quality of each website and number of JAMA requirements met (r=−0.563, P=0.09). The average Flesch Reading Ease Score for all websites was 52.64 (SD 11.94, CI 95%±7.40), and the average Mean Reading Grade was 10.72 (SD 1.58, CI 95%±0.98). There was a significant difference in Mean Reading Grades between websites (H=23.703, P=0.005). There was no significant correlation between content quality of the website and Mean Reading Grade (r=−0.552, P=0.098).
Conclusion:
Commonly accessed online resources on cataracts and cataract surgery are insufficient to provide patients with a clear and complete understanding of their condition as well as available medical and surgical treatment options.
Keywords: Cataract surgery, patient education, readability, online resources
Introduction
Oftentimes in the setting of a new diagnosis of a medical condition, patients utilize the internet as a means for instant access to a wide scope of information when contemplating diagnostic and treatment options.1 While there is undoubtedly a great breadth of data available online, there are no guidelines or regulations in place to ensure that the information accessed by patients is accurate, clear, and comprehensive. Sixty percent of patients using the internet for medical information do not discuss it with their doctors, and many perceive websites to be an equal or better resource than their physician.1 Moreover, some patients feel confident using the information they gain from online resources to guide their medical decisions.2 This places a great deal of responsibility on online resources to convey medical information in a manner that can guide patients towards a safe and optimal decision.
In the ophthalmology landscape, cataracts are the leading cause of bilateral low vision in the United States among white, black, and Hispanic populations.3 Specifically, approximately 20.5 million Americans, or 17.2% of those over the age of 40 have cataracts in one or both eyes.4 The high prevalence of cataracts coupled with patients’ reliance on the internet emphasizes the need to ensure that the information available online can guide medical decisions relating to cataracts and cataract surgery.
Previous studies have demonstrated that ophthalmology information presented online often exceeds the readability of the target patient audience.11,12,13 However, these studies failed to examine the content of material included. A study found that online resources pertaining to diabetic retinopathy are in general of low quality and exceed the recommended reading level, but these results cannot be extrapolated to encompass other ophthalmic conditions.14 Currently, no data exists on the content and readability of information specifically pertaining to cataracts and cataract surgery. This study aims to evaluate online resources on cataracts and cataract surgery for their content accuracy and completeness as well as readability to determine if the information presented can safely guide patients to making informed medical decisions.
Methods
Website Content Evaluation
Evaluated websites were selected based on resources accessible to patients who may complete a Google search on “cataracts” or “cataract surgery”. A Google search was conducted on January 21st 2020 and the top ten displayed results were chosen for analysis. These websites included American Academy of Ophthalmology (https://www.aao.org/), All About Vision (https://www.allaboutvision.com/), American Optometric Association (https://www.aoa.org/), EyeWiki (https://eyewiki.org/), Mayo Clinic (https://www.mayoclinic.org/), Medical News Today (https://www.medicalnewstoday.com/), MedicineNet (https://www.medicinenet.com/), National Eye Institute (https://nei.nih.gov/), WebMD (https://www.webmd.com/), and Wikipedia (https://www.wikipedia.org/). Pubmed (https://www.ncbi.nlm.nih.gov/pubmed/) was added as a gold standard for peer-reviewed resources containing information about cataracts and cataract surgery. A grading sheet was created by the authors based on group discussion of 40 common questions patients may have for their ophthalmologists upon being diagnosed with cataracts (Appendix). These questions were designed by the authors to evaluate the quality and breadth of content available on each website. A vitreoretinal surgeon (JS), a senior vitreoretinal surgery fellow (NY), and a cornea/refractive surgery fellow (NV) individually scored each website’s ability to address each of the 40 questions on the grading sheet on a scale of 0-4. A score of 0 implied the complete absence of information pertaining to the question. A score of 1 indicated reference to the given question but omission of pertinent or accurate information and disorganization or lack of clarity. A score of 2 indicated a partially complete answer with lack of some relevant information and organization. A score of 3 demonstrated an adequate answer to the question with the most relevant information. Lastly, a score of 4 was given when there was a comprehensive answer with organization, clarity, and direction. These scores were then used to assess the quality of each website. The average number of points awarded by each scorer were compared to assess the interobserver reproducibility. The scores were also compared to the website’s rank when “cataract surgery” was searched on Google.com.
Accountability Analysis
In addition to content analysis, each scorer additionally evaluated the accountability of each website according to Journal of the American Medical Association (JAMA) guidelines. JAMA requires each website to include authorship, attributions, disclosure, and currency.15 A complete list of authors along with their affiliations and credentials must be included, as well as any attributions or referenced sources. The website must also disclose any conflicts of interest, and currency, or recency of information. In order for a website to meet each of the above criteria, all three scorers must have agreed on its fulfillment.
Readability Analysis
Readable, an online readability app (https://app.readable.com/text/), was used to assess the readability of each website using multiple indices: Flesch Reading Ease Score, Flesch Kincaid Grade Level, Gunning Fog Index, Coleman Liau Index, and Simple Measure of Gobbledygook (SMOG) Index. The Flesch Reading Ease Score used a mathematical formula that factored in word length and sentence length to create a score from 1-100, with a higher score indicating easier readability, and a score of 70-80 to be equivalent to an eighth grader’s reading level. The Flesch Kincaid Grade Level, Gunning Fog Index, Coleman Liau Index, and SMOG Index created scores that indicated the US grade level that would need to be achieved in order to understand the text. The websites were ranked according to content and readability, and these rankings were summed to provide an overall ranking based on both criteria.
Statistical Analysis
Statistical analysis was completed using IBM SPSS Statistics for Mac, version 25.0, released August 2017 (Armonk, NY: IBM Corp). For the content analysis, the average score for each website was compared using a Kruskall-Wallis test, a rank-based non parametric test, and pairwise comparisons were analyzed via a post-hoc Don-Bonferroni test. Spearman correlation tests were used to analyze the interobserver reproducibility, as well as the correlation between the average score and ranking on Google.com. Statistical significance was set at P ≤ 0.05 for all tests. For the readability analysis, the mean reading grade level for each website was compared using a Kruskall-Wallis test, and pairwise comparisons were analyzed via a post-hoc Don-Bonferroni test. Spearman correlation tests were used to analyze the correlation between the average score of each website and the mean reading grade level, as well as the correlation between the mean reading grade level and Flesch Reading Ease Score. Statistical significance was set at P ≤ 0.05 for all tests.
Results
Website Content Evaluation
Ten websites were evaluated for their content about cataracts and cataract surgery. Interobserver reproducibility analysis including PubMed as a gold standard was statistically significant for all three scorers (r = 0.904 between JS and NY, r = 0.661 between JS and NV, and r = 0.720 between NY and NV; P ≤ 0.05). The content and accuracy of each website was measured as significantly different from a Kruskall-Wallis test (H = 22.623, P = 0.007), where H indicates the amount of difference between the websites. On average, the scorers granted 90.85 points out of a total possible 160, or 57% (SD 29.93, CI 95% ± 17.69). WebMD received the highest score, with 113.33 points (71%), and All About Vision received the lowest score, with 42.00 points (26%) (Table 1). There was a significant difference between mean scores granted to All About Vision and the gold standard, as well as EyeWiki and the gold standard. The questions which received less than 10 total points from all websites included questions pertaining to impact of prior refractive surgeries, comorbid conditions, monovision refractive targets, multifocal, toric or premium IOL options, signs, symptoms and diagnosis of postoperative endophthalmitis, as well as insurance coverage of certain services (Appendix). There was no significant correlation between website rank on Google.com and the content quality of the website (r = 0.049, P = 0.894).
Table I:
Mean and Total Scores for Websites on Cataracts
| Website | Total Points |
Percentage (Out of 160) |
Mean Points |
SD | CI 95% |
|---|---|---|---|---|---|
| AAO | 106.33 | 66% | 2.66 | 1.45 | 0.45 |
| All About Vision | 42.00 | 26% | 1.05 | 1.49 | 0.46 |
| AOA | 87.67 | 55% | 2.19 | 1.60 | 0.50 |
| EyeWiki | 53.33 | 33% | 1.33 | 1.55 | 0.48 |
| Mayo Clinic | 85.00 | 53% | 2.13 | 1.44 | 0.45 |
| Medical News Today | 86.00 | 54% | 2.20 | 1.53 | 0.47 |
| MedicineNet | 78.00 | 49% | 1.96 | 1.54 | 0.48 |
| NEI | 82.00 | 51% | 2.08 | 1.56 | 0.48 |
| WebMD | 113.33 | 71% | 2.83 | 1.28 | 0.40 |
| Wikipedia | 105.67 | 66% | 2.64 | 1.42 | 0.44 |
Accountability Analysis
No websites complied with all 4 JAMA criteria for authorship, or even met 3 of the criteria. 1 website (EyeWiki) met 2 criteria, 5 websites met 1 criterion, and 4 websites met no criteria. Authorship and currency were the only two criteria present in any of the websites. (Table 2). There was no correlation between the content quality of each website and its number of JAMA requirements met (r = −0.563, P = 0.09).
Table II:
JAMA Benchmarks
| JAMA Benchmarks |
N (%) |
|---|---|
| 4 Benchmarks | 0 (0%) |
| 3 Benchmarks | 0 (0%) |
| 2 Benchmarks | 1 (10%) |
| 1 Benchmark | 5 (50%) |
| 0 Benchmars | 4 (40%) |
| Attribution | 0 (0%) |
| Authorship | 4 (40%) |
| Currency | 3 (30%) |
| Disclosure | 0 (0%) |
Readability Analysis
The average Flesch Reading Ease Score for all websites was 52.64 (SD 11.94, CI 95% ± 7.40), and the average Mean Reading Grade was 10.72 (SD 1.58, CI 95% ± 0.98). WebMD had the highest Flesch Reading Ease Score and the lowest Mean Reading Grade (72.6 and 7.78 respectively), implying highest readability. EyeWiki had the lowest Flesch Reading Ease Score and the highest Mean Reading Grade (29.2 and 12.8 respectively), implying lowest readability (Table 3). There was a significant correlation between the Flesch Reading Ease Score and the Mean Reading Grade (r = 0.988, P < 0.001). There was a significant difference in the Mean Reading Grades between the websites (H = 23.703, P = 0.005) (Appendix). There was no significant correlation between the content quality of the website and the Mean Reading Grade (r = −0.552, P = 0.098). Overall ranking of the websites using content and readability scores revealed WebMD to be the best resource and EyeWiki to be the worst (Table 4).
Table III:
Readability Analysis
| Readability | AAO | All About Vision |
AOA | EyeWiki | Mayo Clinic |
Medical News Today |
MedicineNet | NEI | WebMD | Wikipedia |
|---|---|---|---|---|---|---|---|---|---|---|
| Flesch Reading Ease | 64.4 | 52.9 | 50.1 | 29.2 | 52.5 | 55.7 | 48.3 | 62.5 | 72.6 | 38.2 |
| Mean Reading Grade | 8.65 | 11.13 | 11.65 | 12.98 | 11.00 | 10.33 | 12.13 | 9.43 | 7.78 | 12.15 |
| Mean Reading Grade SD | 1.18 | 1.16 | 1.25 | 0.90 | 1.21 | 1.20 | 1.69 | 1.33 | 1.43 | 1.07 |
| Mean Reading Grade CI (95%) | 1.16 | 1.14 | 1.23 | 0.88 | 1.19 | 1.18 | 1.66 | 1.30 | 1.40 | 1.05 |
Table IV:
Content + Readability Ranking
| Rank | Website |
|---|---|
| 1 | WebMD |
| 2 | AAO |
| 3 | Medical News Today |
| 4 | NEI |
| 5 | AOA |
| 6 | Mayo Clinic |
| 7 | Wikipedia |
| 8 | All About Vision |
| 9 | MedicineNet |
| 10 | Eyewiki |
Discussion
The internet has become a main source of information about healthcare, and many patients feel comfortable using this information to guide their medical decisions with little communication with their physicians.1,2 In order to ensure that patients are not making misguided decisions, websites must be evaluated to determine if the content is sufficient to give patients a comprehensive understanding about their condition. This study aimed to evaluate the 10 commonly found websites on Google search providing information on cataracts and cataract surgery for content accuracy, clarity, and completeness, as well as website readability. This particular search engine was utilized because the vast majority of internet users rely on Google for their internet searches.20 A study by Keane et al. demonstrated that people are biased to select items towards the top of the list presented by Google.21 Furthermore, a higher ranking position in Google is associated with reputability.22 Of note, there was no significant correlation between a website’s ranking on Google and its quality and completeness, indicating that the sources patients may turn to first are not necessarily the most capable at providing satisfactory information.
One of the main concerns regarding online patient education on cataracts and cataract surgery is the quality and thoroughness of the information provided. The material should be presented in a clear and focused manner and be scientifically accurate. Inaccurate or incomplete information can hinder the patient from gaining complete understanding of his/her diagnosis and treatment options and ultimately lead to adverse health outcomes.7 There was a significant difference between websites in the content and accuracy of cataract and cataract surgery related information. Interestingly, the websites we evaluated ranged from successfully answering 26% to 71% of the information patients may require to make an informed decision. This wide range portrays the need to direct patients towards certain resources and away from others. WebMD had the highest quality of information while maintaining a low reading grade level, indicating that it would be an excellent resource for patients to utilize. However, it met none of the JAMA benchmarks, which is concerning because it indicates that the website offers no accountability, disclosure, or indication of currency. On the other hand, EyeWiki, the only website that met 2 of the JAMA benchmarks, was second to last in content quality and completeness and lowest in readability. These findings are not surprising as EyeWiki is a resource created by the American Academy of Ophthalmology for physician education, and patients would find a lack of relevant content and information presented at an appropriate reading level. Nevertheless, it is still accessible for public consumption and appears as a top result on Google search; as such, it was evaluated in this study.
Certain topics were poorly addressed by all websites. Of note, the risk of cataract surgery in patients as well as intraocular lens options in patients with comorbid ophthalmic diseases such as age-related macular degeneration and glaucoma did not receive attention from most websites. A study by Tielsch et al. found that cataract patients with ocular comorbidities had a more drastic difference between preoperative expectations and postoperative reality when compared to patients without ocular comorbidities.16 This distinction could be minimized if patients had access to more comprehensive information about their specific situation from online resources. Discussions of post-operative refractive targets, such as monovision or usage of toric or multifocal IOL options, were limited. The websites also rarely discussed the implications of prior refractive surgery in pre-operative and intra-operative surgical planning, intraocular lens selection, and post-operative outcomes. Market Scope predicts that the demand for refractive surgery will grow at a compound annual rate of 5.2% from 2018 to 2023, and the number of surgeries performed globally each year will grow from 4.3 million to 5.5 million.17 This increasing demand will mean more cataract surgery candidates will have a history of refractive surgery in the near future, emphasizing the need for coverage of this issue online. In addition, variations to traditional cataract surgery, such as femtosecond laser-assisted cataract surgery which is rising in usage among cataract surgeons, were not explored in depth.18 There was also a lack of information on post-operative concerns such as dissatisfaction with premium IOLs, treatment options for poor refractive outcomes, or postoperative endophthalmitis. A study by Tan et al. surveyed 100 cataract patients about specific risks that they wanted more information about prior to cataract surgery. Forty-six patients were open to a general discussion about possible complications, and of these, 25 were inquisitive about specific conditions, including endophthalmitis and retinal detachments.19 Insurance coverage was also omitted from the discussion on most websites. These topics indicate gaps in information that patients would have if relying on the internet as a main source of education.
Publicly available data must also be easy for the patient to comprehend and the readability of the text must be appropriate for the patient’s reading and literacy level. In order for 85% of the general public to understand written material, a readability level of eighth grade or less is recommended by Readable, an online readability app that assesses the readability of each website using multiple indices.8 The American Medical Association (AMA) recommends that printed health information be presented at a reading level that is between fifth and sixth grade.9 However, much of the information available online does not meet these recommendations. A study by Daraz et al. found that the mean readability of websites containing health information ranged between a US reading grade level of 10 and 15 (reading level above 12 implies college level).10 Information portrayed at a reading level above a patient’s capabilities can lead to misunderstandings and misinterpretation of information about cataracts and cataract surgery. The readability indices used in this study demonstrated the websites’ level of complexity, representing the US grade level that must be achieved in order to understand the text. The readability of the websites evaluated ranged from a reading grade of 7.78 to 12.98. While PubMed was used as the gold standard for content analysis, it was not included in the readability evaluation since it is not intended for patient use. It is suggested that websites aimed for the general public should present information at a reading grade level of 8, which would allow 85% of the general population to be able to read the material.8 Only one of the websites, WebMD, succeeded in meeting this recommendation, demonstrating that most of the information patients are accessing online about cataracts and cataract surgery is difficult for them to read and comprehend. Furthermore, no significant correlation was found between the content quality and accuracy of a website and its readability, indicating that the sites that patients are able to understand the most may be insufficient in properly educating them about cataracts. This poses a barrier for patients attempting to make sound medical decisions based on online resources.
In addition to determining treatment decisions, a patient’s understanding about cataracts can influence his/her overall satisfaction with surgery. A study by Panagiotopoulou et al. found that a patient’s postoperative perception of cataract surgery was affected not only by the outcome of the surgery, but also by his/her preoperative expectations. Unrealistic expectations, ocular comorbidities, and health literacy levels are among the factors that can influence patient satisfaction after cataract surgery.5 In addition, a study by Choi et al. found that a lack of understanding of cataract surgery can lead to high anxiety, dissatisfaction, and disregard for physician instructions during the pre- and post-operative period.6 Thus, inadequate information online may not only misguide patient decisions but also increase the risk for adverse outcomes, further demonstrating the immense impact the internet can have on a patient’s health.
Our study has several limitations. The list of questions was a non-standard inclusive list generated based on the three graders’ unanimous assessment of questions most pertinent to cataract patients based on both available literature and anecdotal experience. Only the top 10 websites were included in this study, undoubtedly leaving out some resources that patients may encounter. A more extensive list could be more precise and indicative of the quality of information available online. In addition, cataract patients were not surveyed for their use of the internet for cataract information and dependence on online resources for guiding their decisions. A future study including this aspect may provide clarity on the severity of this issue. Lastly, this study is specific to cataract and cataract surgery, and cannot be confidently extrapolated to other ophthalmic diseases.
Despite these limitations, the study results indicate that the information on cataract and cataract surgery available online varies in its content, accuracy, completeness, readability, and accountability. Overall, online resources are lacking in their ability to efficiently provide patients with trustworthy and sufficient information to guide them in decision making. Ophthalmologists should be cautious of patients’ internet use and initiate conversations about seeking information online to ensure patients are making sound medical decisions, and as a field further study and efforts may be geared towards producing more accurate and readable content for the layperson.
Appendix
Table I:
Questionnaire About Cataracts with Mean and Total Scores
| Mean Pointsa | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Questions | AAO | All About Vision |
AOA | Eye Wiki |
Mayo Clinic |
Medical News Today |
MedicineNet | NEI | Web MD |
Wikipedia | Total |
| What is a cataract? | 4.00 | 4.00 | 4.00 | 4.00 | 4.00 | 4.00 | 4.00 | 4.00 | 4.00 | 4.00 | 40.00 |
| What are the symptoms associated with cataracts? | 4.00 | 3.67 | 4.00 | 4.00 | 3.33 | 4.00 | 4.00 | 4.00 | 4.00 | 4.00 | 39.00 |
| How are cataracts diagnosed? | 4.00 | 1.00 | 3.67 | 3.67 | 1.67 | 3.33 | 4.00 | 2.67 | 4.00 | 3.00 | 31.00 |
| Once diagnosed, how often should I see my doctor for cataracts? | 4.00 | 0.00 | 1.00 | 0.00 | 1.00 | 1.67 | 1.33 | 1.33 | 3.67 | 0.00 | 14.00 |
| What are the risk factors for cataracts? | 4.00 | 4.00 | 4.00 | 4.00 | 1.33 | 4.00 | 4.00 | 3.67 | 3.67 | 4.00 | 36.67 |
| Could changing my glasses prescription help improve my vision through cataracts? | 4.00 | 3.67 | 3.67 | 1.67 | 2.33 | 3.33 | 3.33 | 3.50 | 3.00 | 2.67 | 31.17 |
| Can anything be done to slow the progression of cataracts? | 2.00 | 3.67 | 2.00 | 2.00 | 0.00 | 4.00 | 3.33 | 3.00 | 3.67 | 3.33 | 27.00 |
| Is there a risk to waiting to remove my cataracts? | 1.67 | 0.00 | 1.00 | 0.67 | 3.33 | 2.00 | 3.67 | 4.00 | 3.00 | 1.00 | 20.33 |
| How are cataracts treated? | 4.00 | 2.33 | 4.00 | 3.67 | 2.67 | 4.00 | 4.00 | 3.33 | 3.67 | 4.00 | 35.67 |
| Are there any nonsurgical treatments for cataracts? | 1.67 | 3.00 | 2.33 | 3.33 | 1.33 | 2.00 | 2.33 | 3.33 | 2.33 | 2.33 | 24.00 |
| How does cataract surgery work? | 4.00 | 2.33 | 3.33 | 3.00 | 3.33 | 3.67 | 3.33 | 2.00 | 3.00 | 4.00 | 32.00 |
| When should cataract surgery be considered? | 3.67 | 3.33 | 4.00 | 2.00 | 4.00 | 3.67 | 3.67 | 4.00 | 3.67 | 4.00 | 36.00 |
| How long does it take to recover from cataract surgery? | 2.33 | 0.00 | 4.00 | 0.00 | 3.33 | 3.00 | 1.50 | 3.67 | 3.33 | 3.00 | 24.17 |
| What are the risks of cataract surgery? | 4.00 | 0.00 | 4.00 | 0.00 | 4.00 | 1.00 | 3.33 | 3.67 | 3.67 | 4.00 | 27.67 |
| Is there pain associated with cataract surgery? | 3.33 | 0.00 | 1.00 | 0.00 | 1.67 | 1.67 | 1.00 | 2.33 | 3.00 | 2.67 | 16.67 |
| What type of anesthesia is used for cataract surgery? | 3.33 | 0.00 | 1.00 | 0.00 | 3.67 | 3.00 | 2.67 | 1.67 | 3.00 | 3.67 | 22.00 |
| Can I have cataract surgery if I have had LASIK/PRK before? | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 |
| Are there additional concerns of cataract surgery in patients with age-related macular degeneration? | 0.67 | 0.00 | 3.67 | 0.00 | 0.67 | 0.00 | 2.33 | 2.00 | 0.00 | 0.00 | 9.33 |
| Am I a candidate for a premium IOL if I have AMD or glaucoma? | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.67 | 0.00 | 0.00 | 0.00 | 0.67 |
| What is a monofocal intraocular lens? | 3.67 | 1.33 | 3.67 | 1.33 | 3.33 | 3.67 | 2.67 | 0.00 | 3.67 | 3.00 | 26.33 |
| What is a toric intraocular lens? | 3.67 | 0.00 | 3.67 | 1.33 | 2.67 | 3.33 | 0.00 | 0.00 | 3.67 | 1.33 | 19.67 |
| What is a multifocal intraocular lens? | 3.33 | 1.33 | 3.67 | 1.33 | 2.67 | 3.33 | 2.33 | 0.00 | 3.67 | 2.67 | 24.33 |
| What is monovision? | 0.00 | 0.00 | 0.00 | 0.33 | 0.00 | 0.00 | 0.00 | 0.00 | 1.33 | 1.33 | 3.00 |
| What is posterior capsular opacification (PCO) and how is it treated? | 4.00 | 0.00 | 4.00 | 0.00 | 4.00 | 1.33 | 3.00 | 3.33 | 4.00 | 4.00 | 27.67 |
| What is phacoemulsification? | 3.67 | 0.00 | 3.00 | 3.33 | 4.00 | 3.33 | 3.67 | 0.00 | 3.00 | 4.00 | 28.00 |
| How long will it take my vision to recover after cataract surgery? | 1.67 | 0.00 | 2.67 | 0.00 | 3.67 | 3.00 | 0.67 | 3.33 | 3.67 | 3.00 | 21.67 |
| Will I have to use drops after surgery? | 3.67 | 0.00 | 1.67 | 0.00 | 3.67 | 2.33 | 0.00 | 3.67 | 3.33 | 1.33 | 19.67 |
| Will I need to wear corrective lenses or reading glasses after cataract surgery? | 3.33 | 3.33 | 3.33 | 1.00 | 3.67 | 3.67 | 1.67 | 2.67 | 3.67 | 1.33 | 27.67 |
| How does laser-assisted cataract surgery differ from traditional cataract surgery? | 4.00 | 0.00 | 0.00 | 2.00 | 2.67 | 1.00 | 0.00 | 0.00 | 2.33 | 1.33 | 13.33 |
| What are the current indications for laser-assisted cataract surgery? | 3.33 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.67 | 0.33 | 4.33 |
| What are the signs and symptoms of infection after cataract surgery? | 1.67 | 0.00 | 0.00 | 0.00 | 1.67 | 0.00 | 0.00 | 2.33 | 3.67 | 4.00 | 13.33 |
| What are the signs and symptoms of retinal detachment after cataract surgery? | 1.00 | 0.00 | 0.00 | 0.00 | 1.00 | 0.00 | 0.00 | 4.00 | 4.00 | 4.00 | 14.00 |
| What is postoperative endophthalmitis? | 0.33 | 0.00 | 0.00 | 0.00 | 0.00 | 0.33 | 0.67 | 0.00 | 2.33 | 4.00 | 7.67 |
| Will my cataract regrow after cataract surgery? | 3.00 | 0.00 | 3.00 | 0.00 | 2.67 | 1.00 | 3.33 | 3.67 | 3.67 | 3.67 | 24.00 |
| Will I need additional surgery or laser treatments after cataract surgery? | 2.00 | 0.00 | 1.67 | 0.00 | 3.33 | 1.00 | 0.00 | 1.00 | 3.33 | 3.00 | 15.33 |
| If I do not like the IOL implant I got, can it be replaced or can my prescription be changed with laser? | 0.00 | 0.00 | 0.00 | 0.00 | 0.67 | 0.00 | 0.00 | 0.00 | 0.67 | 0.67 | 2.00 |
| Will my insurance company pay for all types of intraocular lenses? | 0.67 | 0.00 | 0.00 | 0.00 | 0.00 | 3.50 | 0.00 | 0.00 | 0.00 | 1.33 | 5.50 |
| What is the incidence of cataracts? | 0.67 | 1.67 | 0.67 | 2.67 | 1.33 | 4.00 | 2.00 | 1.67 | 1.00 | 3.67 | 19.33 |
| Which age group is most commonly affected by cataracts? | 4.00 | 3.33 | 3.67 | 4.00 | 2.33 | 4.00 | 4.00 | 3.67 | 3.00 | 4.00 | 36.00 |
| Does the source show pictures of cataracts? | 4.00 | 0.00 | 2.33 | 4.00 | 0.00 | 0.67 | 2.00 | 1.67 | 4.00 | 4.00 | 22.67 |
| Total Points | 106.33 | 42.00 | 87.67 | 53.33 | 85.00 | 86.00 | 78.00 | 82.00 | 113.33 | 105.67 | |
| Percentage (Max 160) | 66% | 26% | 55% | 33% | 53% | 54% | 49% | 51% | 71% | 66% | |
| Points, Mean | 2.66 | 1.05 | 2.19 | 1.33 | 2.13 | 2.20 | 1.96 | 2.08 | 2.83 | 2.64 | |
| SD | 1.45 | 1.49 | 1.60 | 1.55 | 1.44 | 1.53 | 1.54 | 1.56 | 1.28 | 1.42 | |
| CI 95% | 0.56 | 0.57 | 0.61 | 0.59 | 0.55 | 0.59 | 0.59 | 0.60 | 0.49 | 0.54 | |
Scores of individual questions scaled from 0-4
Table II:
Pairwise Comparison of Website Mean Reading Grade
| Website | H | P |
|---|---|---|
| WebMD – AOA | 20.375 | 0.615 |
| WebMD – MedicineNet | 22.25 | 0.319 |
| WebMD – Wikipedia | −23.625 | 0.191 |
| WebMD – EyeWiki | 28.625 | 0.024 |
| AAO – MedicineNet | −20 | 0.698 |
| AAO – Wikipedia | −21.375 | 0.436 |
| AAO – EyeWiki | −26.375 | 0.064 |
| NEI – EyeWiki | 21.75 | 0.382 |
Footnotes
Disclaimer – The views expressed in this article are of the authors and are not an official position of the University of Miami.
Source of Support: N/A
Disclosure of Interest: The authors report no conflict of interest.
References
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