QUALITY AND READABILITY OF ONLINE INFORMATION ON KERATOCONUS IN PORTUGAL

Keratoconus is the most common primary corneal ectasia. Patients search the Internet for answers regarding its diagnosis, treatment, and prognosis. However, such information is not filtered or subject to quality control before getting published on most webpages. We aim to evaluate the quality and readability of Portuguese written online information regarding keratoconus.

Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal

Two independent ophthalmologists and one ophthalmologist supervisor evaluated 31 websites obtained from a Google search query with the word “Queratocone” (Portuguese word for keratoconus), by order of appearance, using 2 quality scores: the quality index of consumer health information (DISCERN) and the Journal of the American Medical Association (JAMA) benchmark. The readability was evaluated using 3 scores: FleschKincaid Reading Ease (FRE), FleschKincaid Grade (FKG) and Automated Readability Index (ARI). The presence of a website quality seal was noted.

We obtained 12 websites (38.70%) from private hospitals or clinics, 5 (16,13%) from online health platforms, 4 (12,90%) from spectacle/contact lenses companies, and 10 (32.26%) from other varied sources. The average score for each JAMA benchmark item was: 1: 0,48±0,51, 2: 0,32±0,48, 3: 0,03±0,18 and 4: 0,42±0,50; the average final score was: 1,26±1,24 (possible range: 0 to 4; higher is better). The average score for each DISCERN section was: 1: 17,42±7,56, 2: 15,68±5,68 and 3: 2,45±1,21; the average final score was 35,55±13,63 (possible range: 16 to 80; higher is better). The mean FRE score was 32,23±12,98, which corresponds to “difficult to read” and to college education level, as well as a concordant mean FKG of 14,72±3,24. The mean ARI was 14,81±4,09, which denotes “professor” level needed to understand the text. Eleven websites (35,48%) exhibited a quality seal and did not show statistically significantly better readability or quality scores than sites without a quality seal. There was no significant correlation between google ranking and quality or readability scores.

The information on keratoconus that is available online to Portuguese speaking patients is, overall, of poor quality and difficult to interpret. Nonetheless some patients might fully trust their own online research. Ophthalmologists have a shared responsibility to tackle this challenge through multifold efforts, aiming to improve the information that is available online, and educating patients on how to find reputable websites that provide reliable information on keratoconus.