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Table 1 Characteristics of the 13 included studies

From: Readability of patient education materials in ophthalmology: a single-institution study and systematic review

Study Materials Evaluated n Articles Evaluated Medium Evaluation Methods Results Conclusions
Barbosa and Martins (2007) [26] Internet information about floaters and light flashes found by two search engines, MetaCrawler and MSN. 49 Online FKGL and quality component scoring system Mean FKGL = 9.9 “It is important for ophthalmologists not only to help to develop good-quality websites but also to direct their patients to sites that provide accurate information.”
Brown, et al. (2004) [25] Cataract information leaflets from 12 ophthalmology departments in England 12 Print SMOG, criteria for obtaining informed consent Mean SMOG = 10 SMOG scores exceed recommended level of 5 or lower
Ebrahimzadeh, et al. (1997) [24] Educational brochures from the AAO 22 Print FKGL, FRES, GFI 32 % were at or below an 8th-grade reading level, 55 % between 8th- and 10th-grade levels, and 15 % were a 10th-grade reading level or higher “With aid of computer programs, reading levels of materials can be analyzed and revised to reflect low health literacy”
Edmunds, et al. (2013) [19] The “top 10 patient-oriented websites for 16 different ophthalmic diagnoses” 160 Online FKGL, FRES, SMOG, GFI Mean FKGL = 11.3 “[R]eadability scores were inferior to those recommended, irrespective of the measure used....we recommend the use of readability scoring when producing such resources in the future.”
Edmunds, et al. (2014) [27] “[O]nline literature specifically for Graves’ disease and thyroid-associated ophthalmopathy” by Google search 50 Online FKGL, FRES, SMOG, GFI Mean FKGL = 11 “None of the web pages evaluated had readability scores in accordance with published guidelines....Screening of this online material, as well as subsequent revision, is crucial to increase future patient knowledge, satisfaction, and compliance.”
Hansberry, et al. (2014) [28] Patient education material on AAO website unspecified Online FKGL, FRES, SMOG, GFI, Coleman-Liau Index, the New Fog Count Formula, the New Dale-Chall Readability Formula, FORCAST formula, Raygor Readability Estimate, and the Fry Graph Mean FKGL = 11.7 “[W]e believe revisions in line with the recommendations of the NIH may be warranted to improve patient comprehension”
Huang, et al. (2015) [29] Websites from 7 ophthalmologic organizations: AAO, American Association of Ophthalmic Oncologists and Pathologists, AAPOS, AGS, ASCRS, ASOPRS, American Society of Retina Specialists, American Uveitis Society, Cornea Society, and NANOS 339 Online FKGL, FRES, SMOG, GFI, Coleman-Liau Index, New Fog Count, New Dale-Chall Readability Formula score, FORCAST score, Raygor Readability Estimate Graph score, and Fry Readability Graph score. Mean FKGL ranged from 10.4 to 12.6 “Online PEMs on major ophthalmologic association websites are written well above the recommended reading level. Consideration should be given to revision of these materials to allow greater comprehension among a wider audience”
John, et al. (2015) [30] First 10 PEMs to appear in search on Google search for 10 pediatric ophthalmology conditions 100 Online FKGL, FRES, SMOG, GFI, Coleman-Liau Index, New Dale-Chall, FORCAST Formula, Fry Graph, Raygor Reading Estimate, and the New Fog Count Mean FKGL = 11.75 Only 12 % of articles were written below a 9th-grade level and only 3 % met recommended criteria.
Khurana, et al. (2003) [23] Various ocular medication inserts 10 glaucoma medication inserts, 6 nonglaucoma inserts Print FKGL, SMOG Mean FKGL = 12.9 (glaucoma inserts), Mean FKGL = 11.1 (nonglaucoma inserts) All medications reviewed were written above an 8th-grade reading level
Martins and Morse (2005) [31] Websites about retinopathy of prematurity found by two search engines, MetaCrawler and MSN. 40 Online FKGL and quality component scoring system Mean FKGL = 10.83 “In the majority of the sites (62.5 %) the ROP information was fair or poor.”
Muir and Lee [2] (2010) Educational brochures from the AAO (Revised in 2008), NIH, NEI, AGS, the Glaucoma Research Foundation, and Prevent Blindness America 49 Print FKGL Mean FKGL = 8.3 (AAO), 9.7 (non-AAO) “Unfortunately, there is still a dearth of written ophthalmic educational materials available from any agency for the least literate patients, precisely those who are at the greatest risk of blindness.”
Williams, et al.a Duke Eye Center Glaucoma Guide (patient education material about various glaucoma topics written by Duke faculty) 12 Print FKGL, FRES, SAM, word count Mean FKGL = 10.0 (before revision); Mean FKGL = 6.4 (after revision) Revisions of patient education materials using existing guidelines significantly improved their readability and suitability for a low-health-literacy population
Zaidi and Jones (2009) [32] Websites that appear in the first 5 pages of a Google search for three terms related to blepharoplasty 101 Online Objective quality of each website was measured using JAMA criteria: declaration of authorship, attribution of sources, disclosure of conflict of interests, and provision of date content was posted or updated (1 point for each, maximum 4 points total) “Most sites scored low for quality—40 % scored zero for objective quality; 41 % scored just one point; 10 % scored two points; 6.5 % of sites scored three points; only 2.5 % of sites scored favourably on all four criteria.” “This study identifies the poor quality of information on oculoplastic surgery, which is available to patients using the internet”
  1. aThe present study
  2. AAO American Academy of Ophthalmology, AAPOS American Association for Pediatric Ophthalmology and Strabismus, AGS American Glaucoma Society, ASCRS American Society of Cataract and Refractive Surgery, ASOPRS American Society of Ophthalmic Plastic and Reconstructive Surgery, FKGL Flesch-Kincaid Grade Level, FRES Flesch Reading Ease Score, GFI Gunning Fog Index, JAMA Journal of the American Medical Association, NANOS North American Neuro-Ophthalmology Society, NEI National Eye Institute, NIH National Institutes of Health, PEMs Patient Education Materials, SAM Suitability Assessment of Materials, SMOG Simple Measure of Gobbledygook