Does social media have a place in ophthalmology practice?

1. Introduction

Within the past decade, social media has become an integral part of everyday life. In 2020, over 3.6 billion people used it worldwide, a statistic projected to increase to almost 4.41 billion by 2025.¹ In the first quarter of 2020, Twitter alone reported that its average daily users increased by 24% over the previous year to 166 million daily users.² Given the increasingly pervasive impact of social media in daily life, the question arises: Does social media have a place in ophthalmology practice?

2. Social media in ophthalmology and medicine

2.1. Possible uses

Social media platforms provide an avenue of potential exposure and outreach to a vast audience of users within medicine. As healthcare providers in a very visual specialty, ophthalmologists have a unique opportunity to use social media as a route for public education and a tool to advance patient care. The American Academy of Ophthalmology (AAO) has identified Facebook, Twitter, Blogging, LinkedIn, and Doximity as the top five social media platforms, but providers are also increasingly turning to Instagram, TikTok, among others.³ Ophthalmologists can take advantage of platforms to conduct epidemiological investigations, disseminate information, raise awareness, communicate with patients, and integrate ophthalmic health into users’ personal daily lives.

2.2. Patient outreach

Patient outreach is a primary goal of social media usage in ophthalmology practices. A study by Al-khersan et al. found that of 160 ophthalmologist respondents, 39.4% reported using social media for professional use, of whom 27% had their own professional page, 55.6% had a practice/institutional page, and 17.5% had both.³ Patients were identified as the target population of social media pages among 34.9% of the ophthalmologists surveyed, while both patients and other professionals were the target for an additional 55.6% of respondents.⁴

Clarke et al. analyzed Lasik surgery Instagram and Twitter posts by patients using the hashtag #lasiksurgery. The investigators found that 92% of patients posted photographs, 88% had a positive tone, 62% referenced the clinic at which they were treated, and 44% posted during the day of the procedure.⁵ Understanding patients’ usage of their social media is important in determining how to best interact with them.

Lastly, the utility of social media to communicate ophthalmic clinical instructions to patients has also been studied. For example, platforms were used to send instructions and appointment reminders to post-operative cataract patients.⁴ In one study, investigators found that messaging patients regarding post-operative instructions after cataract surgery led to better medication compliance at one week,⁶ though this effect was lost at the one-month mark. Overall, social media may be leveraged in the future alongside email and medical record messaging applications to more effectively reach patients.

2.3. Education between providers

Social media also allows for ophthalmologists to efficiently collaborate with and educate one another. The use of social media as an educational tool has been particularly highlighted during the COVID-19 pandemic. Global communication between physicians in the United States, Australia, China, Italy, Korea, Singapore, and the United Kingdom on social media allowed for the comparison of risk mitigation efforts while treating asymptomatic COVID-19 patients as well as uses of personal protective equipment in the clinical setting.⁷ When Asia and Italy suffered the effects of the COVID-19 pandemic prior to the United States and other countries, sharing videos, research papers, and medical information via social media served as a forewarning to unaffected geographic regions. Social media was a major source of public education during the pandemic as authorities such as the National Institute of Health and World Health Organization utilized campaigns to encourage mask-wearing, hand hygiene, and social distancing worldwide.²

Further, designs for slit-lamp biomicroscope shields and imaging instrumentation to protect against COVID-19 transmission were circulated on social media among clinical practices.² Wong et al. published a report in mid-February 2020, weeks before the beginning of the COVID-19 surge in the United States, which called attention to the possibility of transmission of COVID-19 via tears.² The report also proposed ophthalmic manifestations of COVID-19. Having this information, clinics and hospitals in the United States were able to prioritize the implementation of protective eyewear.² The AAO and other professional organizations regularly posted updates on evolving COVID-19 prevention and triage guidelines.

2.4. Educating doctoral trainees

Social media can also be used to educate medical trainees. It is estimated that the majority of medical students use smart phones for education (62.7%), communication (81.7%), and recreation (82.5%).⁸ Of 120 ophthalmology residency programs evaluated, 37.5% had a Facebook page, 24.3% were on Twitter, and 18.3% had an Instagram page.⁹ Among the ophthalmology residency programs ranked as top-20 by Doximity, 80% had at least one social media account compared to only 33% of the remaining programs.⁹ Additionally, the top 20 programs had a greater social media following.⁹ This study highlights that ophthalmology institutions are making an active effort to reach out to medical trainees via social media.

2.5. Educating patients

“Medfluencers” and other doctors on Instagram post photos depicting certain diseases with elaborate captions to educate the public. TikTok allows physicians to edit videos with engaging music, sound, subtitles, dance, movement, and photos. Physicians directly address patients in these videos, and short explanations are given on a dedicated topic.

Twitter serves as a forum for microblogging by physicians and is particularly useful for sharing images or links to websites where readers can learn more.² The AAO Ophthalmology journal Twitter account posts recently published peer-reviewed articles, while the AAO’s account shares routine COVID-19 updates.² The consistent stream of new activity allows Twitter users to readily access valid and accurate medical information.

a. Epidemiological Investigations

Ophthalmologists can use social media to perform statistical analyses for epidemiological investigations for given illnesses. Professionals can monitor certain hashtags to surveil symptoms experienced by patients, calculate disease incidences, and create a timeframe of symptoms and incubation/latency periods.

3. Possible limitations

3.1. Patient privacy

Several potential drawbacks to the use of social media in ophthalmology are worth noting. First, concerns regarding patient privacy laws are a main reason for limited use by ophthalmologists.⁴ Medical professionals often fear violating HIPAA conduct when posting photos of patients. 2018 AAO recommendations regarding the use of social media and professionalism have been published for providers.

3.2. Financial drawbacks for physicians

Another real— and rarely acknowledged— impediment to using social media such as Instagram is the potential need for financing the account, depending on the goals and situation of the user. Organic growth is certainly useful, and in the case of already renowned individuals and institutions, could be sufficient. For the singular ophthalmologist, however, organic growth may not be sufficient. To optimize Instagram’s algorithms and maximize outreach and impressions, posts may need to be monetarily boosted, especially if the account is a business account. A business account carries the advantage of appearing more ‘professional’ for an ophthalmologist attempting to advertise his/her practice. Many practices now have dedicated staff who manage their social media presence. A social media manager or publicist can be hired to remotely manage the practice’s accounts. Thus, the use of social media is a potential financial burden upon the ophthalmologist and ophthalmology practices.

3.3. Time

Maintaining a social media presence can be extremely time-consuming. Directly responding to and engaging with patients is important; however, doing so on top of clinical practice can be burdensome and overwhelming to the ophthalmologist. Al-khersan et al.’s study found that 31.25% of respondents who reported not using social media for professional purposes indicated that it was too time-consuming.⁴

4. Suggestions for getting started on social media

a.). Determine your audience

Targeting your audience (patients, providers, etc.) will allow you to choose the most appropriate platform and better cater your content.

b.). Choose a platform

Different platforms carry different advantages and drawbacks. Consider, for example, whether you want to include video and audio in your posts, in which case an Instagram rather than a Twitter account may be more suitable.

c.). Decide who will run the page

A key to success is routine activity of a social media page, including regular posts and interactions with other accounts. Consider whether you have the time to run your own page or if you are better suited with an account manager curating it.

d.). Generate content

Based on knowledge of your audience, choose the focus of your content: your practice, interesting cases, accomplishments, etc. It is efficient to have content ready to post ahead of time to cultivate regular account activity so long as the information remains relevant.

e.). Review the analytics

Most platforms allow you to see which posts are most successful based on their reach and timing. Review this information to better tailor your future content.

5. Conclusion

Despite potential drawbacks, if approached responsibly, social media has the potential to allow providers to better reach out to their patients and colleagues. Social media has been widely adopted by patients as a regular form of communication and will only increase in prevalence. As such, we encourage ophthalmologists to explore the various social media platforms that best cater to their needs in reaching out to patients, increasing their practice visibility, and interacting with the medical community.