FormalPara Key Summary Points

Why carry out this study?

Social media usage is increasing worldwide, and patients turn to social media platforms for health-related information.

TikTok is a widely utilized video-based social media platform, but there is an absence of studies that assess ophthalmic content, at a comprehensive level, on TikTok.

We aimed to characterize and analyze current trends among popular ophthalmology-related TikTok videos, including the prevalence of misinformation.

What was learned from the study?

Our findings show that the majority of ophthalmic content on TikTok is produced by non-healthcare providers. The presence of misinformation is significantly higher among videos created by non-healthcare providers and is more disproportionately bookmarked and seen by viewers.

There is a pressing need for ophthalmologists to produce more actionable educational content to counter the rapid dissemination of ophthalmology-related misinformation on TikTok.

Introduction

Over 4.59 billion people use social media worldwide with 75% of patients turning to social media first to find health information [1, 2]. Patients often use social media as a means to replace professional consultations with physicians with one study showing that only 50% of parents discuss the pediatric health information that they find on social media with their doctors [3]. Social media content has also been shown to significantly impact patients’ health-related behaviors, but few physicians have embraced social media as an educational tool [4]. A recent cross-sectional study revealed that while approximately 70% of surveyed physicians had social media accounts, only 10% engaged regularly in content creation [5]. In light of extensive health-related misinformation and disinformation on social media platforms [6], there is a pressing need for healthcare professionals to provide more evidence-based health information on social media.

With 1 billion users worldwide [7], TikTok has recently emerged as one of the most popular video-based social media platforms for sharing health information [8]. While ophthalmologic content on other social media platforms such as Instagram and Twitter have been studied [9, 10], the type and quality of ophthalmologic content on TikTok is not well understood. Given the pervasiveness of eye health-related information shared by non-ophthalmologists on other social media platforms, we sought to evaluate the characteristics of popular ophthalmology content on TikTok, including the presence of misinformation.

Methods

Thirty-seven ophthalmology-related hashtag terms were queried utilizing the TikTok search function from April 16 to May 22, 2023, with the mean number of views charted per hashtag as of May 15, 2023 (Table 1). These terms were utilized in a previous survey of ophthalmology content on Instagram, which combined ophthalmology diagnostic terms derived from the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry and eye-related phrases commonly used by the general public [10]. The top 20 most-liked videos for each hashtag were analyzed and assessed for the following seven criteria:

  1. 1.

    Creator identity: Creators were categorized as ophthalmologist versus non-ophthalmologist, eyecare provider (e.g., ophthalmologists and optometrists) versus non-eyecare provider, healthcare provider (e.g., physicians and allied health professionals) versus non-healthcare provider (e.g., layperson, influencer, and business) and were determined in accordance with the creator’s social media profile and linked websites.

  2. 2.

    Content type: Videos were categorized as primarily related to education, entertainment, promotion, patient experience, or personal experience.

  3. 3.

    Patient experience presence and sentiment: Videos containing any mention of patient-related experiences were graded as positive, negative, or neutral.

  4. 4.

    Understandability and actionability scores: Primarily educational videos were assigned understandability and actionability scores via the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) scale.

  5. 5.

    Misinformation presence: Graded as significant, minimal, or none.

  6. 6.

    Engagement metrics: Determined by the number of views, likes, comments, and bookmarks per video.

  7. 7.

    TikTok verification status: Traditionally used by the platform to designate a “notable” figure. Categorized as present or absent.

Table 1 Number of views (in millions as of May 15, 2023), mean likes, mean comments, mean bookmarks, and mean PEMAT A/V understandability and actionability scores for all ophthalmology-related hashtags searched on TikTok
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Veterinary ophthalmic, non-ophthalmology-related, duplicated, and non-English posts were excluded from analysis. This research did not involve human subjects, and ethics committee approval was not required for this study. This research was conducted on publicly available data on TikTok, which is considered to be IRB-exempt based on Exemption 4 of the Common Rule (The Federal Policy for the Protection of Human Subjects). Regarding misinformation presence, the authors characterized misinformation as any ophthalmic-related assertion rooted in anecdotal evidence, falsehood, or deception due to the absence of established scientific understanding. The study design and video assessments were conducted by medical students and an ophthalmic clinical research coordinator under the guidance of an ophthalmologist (cornea, cataract, and refractive surgeon).

Content types were classified into several categories: education, entertainment, promotion, patient experience, and personal experience. Education videos encompassed content focused on teaching various aspects of ophthalmology, including conditions, treatments, and research. Additionally, this category included videos by medical professionals raising awareness about different diagnoses, often featuring case studies, diagnostic images, and procedure demonstrations. Entertainment videos aimed primarily to amuse viewers. Promotion referred to videos promoting specific products or services, essentially functioning as advertisements. Patient experience included videos created by ophthalmologists and healthcare professionals sharing patient testimonials or experiences. The personal experience category encompassed content centered on the subjective experiences of content creators, often presented in a narrative format.

Videos featuring patient-related experiences were evaluated for sentiment and categorized as positive, negative, or neutral. A positive sentiment was assigned when patients expressed satisfaction or happiness, while neutral sentiment indicated indifference. Conversely, negative sentiment was attributed to videos in which patients conveyed common undesirable emotions like anger or frustration.

To address the presence of misinformation, videos suspected of containing false information underwent fact-checking based on currently accepted guidelines within ophthalmology as well as published evidence in the literature. The degree of misinformation within videos was further categorized, with those comprising over 50% misinformation labeled as “significant.” Conversely, videos with less than 50% misinformation in their content were designated as “minimal.”

Assessment of Educational Quality Across Ophthalmology-Related Videos

We assessed the quality of each educational TikTok video using the PEMAT-A/V scale. This is a validated tool that was developed to identify the understandability and actionability of audiovisual patient educational content [11, 12]. The scale is comprised of 13 questions for understandability and four questions for actionability. Each of the 17 items in the instrument is scored as 0 (disagree) or one (agree), with eight items having an additional option of Not Applicable (NA). The percentage score for each subscale ranges from 0 to 100% and is calculated by dividing the total summed points by the total possible points [11, 12]. A low percentage score indicates that the content has deficiencies in terms of understandability and actionability, suggesting that materials may be difficult for patients to comprehend and/or apply to their health-related decision-making, respectively [12]. Conversely, a high percentage score suggests that the educational materials effectively convey information to patients in a way that promotes comprehension and facilitates informed decision-making [12].

Statistical Analysis

IBM SPSS Statistics 29.0 (Armonk, NY, USA) [13] was used to perform the statistical analyses of this cross-sectional study. First, descriptive characteristics were assessed across the data set. This included the frequency of videos across the previously described seven major assessment criteria as well as the hashtags that garnered the highest and lowest PEMAT-A/V scores and engagement metrics. Next, the Shapiro–Wilk test was performed to determine whether normality could be assumed in the distribution of PEMAT-A/V scores and engagement metrics. If normality was violated, we then utilized nonparametric tests to further identify trends in the obtained data. This included Mann–Whitney U tests to determine whether there were significant differences in PEMAT-A/V scores, engagement metrics, TikTok verification status, misinformation presence, and content type between TikTok videos produced by ophthalmologists, eyecare providers, and healthcare providers in comparison to non-ophthalmologists, non-eyecare providers, and non-healthcare providers, respectively. Mann–Whitney U tests were also performed to determine differences in PEMAT-A/V scores and engagement metrics between educational videos with and without misinformation and between videos made by creators with and without TikTok verification status. To further assess the differences in content type among different content creators, we utilized a Mann–Whitney U test to compare the primary content category (educational, entertainment, patient experience, personal experience, or promotional) between ophthalmologists and non-ophthalmologists. Kruskal–Wallis H tests were also used to compare engagement metrics, TikTok verification status, and misinformation presence across such primary content categories. For all statistical analyses, the p value < 0.05 was utilized as the metric for statistical significance.

Results

Ophthalmology-Related Hashtags

Viewership and engagement metrics for the top 20 most-liked videos analyzed for all 37 hashtag terms are shown in Table 1, except for #AgeRelatedMacularDegeneration, in which only 18 relevant videos were available, and #Trabeculoplasty, in which only five relevant videos were available. A total of 723 videos comprising 3.806 billion views met the inclusion criteria for this study. The Cochran’s formula for sample size is an established tool for determining sufficient sample sizes for ideal precision in statistical analyses. For the following three characteristics: (1) very large populations such as the continuously increasing total number of TikTok videos related to ophthalmology, (2) a 95% confidence interval, and (3) a 5% precision level, the sufficient sample size is 385 videos based on the Cochran’s formula. In our study, we analyzed 723 videos in order to further expand the comprehensiveness of our search. All 37 hashtags’ metrics were charted and analyzed separately (Table 1).

The most popular hashtags were “LASIK” (646.1 million views), “Blepharoplasty” (402.4 million), “Ophthalmology” (399.2 million), “EyeSurgery” (287.0 million), “Myopia” (267.4 million), and “Ophthalmologist” (232.5 million). Across 723 videos, there were an average number of 243,011 likes and 10,974 bookmarks per post. One of the videos turned off the commenting feature, and the average number of comments across the remaining 722 videos was 2061 comments.

The hashtags that garnered the greatest and lowest average number of likes were #EyeDisease (748,305) and #PterygiumSurgery (122), respectively. With regards to comments, #Myopia saw the greatest average number of comments (10,191), while #Trabeculoplasty had the lowest (5). Finally, regarding bookmarks (i.e., the number of people who saved a particular TikTok video), #Ophthalmology garnered the highest average number of bookmarks (41,816), while #RetinaSurgery had the lowest (8.7).

Content Creator Identity

A summary of creator characteristics is displayed in Table 2 and Fig. 1. The majority of videos were created by non-ophthalmologists (83.1%) and non-healthcare providers (55.0%). Specifically, content creators were comprised mostly of non-healthcare provider influencers (38.6%), optometrists (18.3%), ophthalmologists (16.9%), laypeople (10.4%), and non-ophthalmologist physicians (5.4%). Students and trainees represented about 1.2% of all posts.

Table 2 Characteristics of ophthalmology-related TikTok videos
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Fig. 1
figure 1

Distribution of content creators across 723 ophthalmology-related TikTok videos. This figure represents a sunburst diagram that shows the distribution of content creators among the 723 videos in this study. The chart begins with the innermost ring and consecutively extends outwards. The first, or innermost, ring provides a visual depiction of the percentage distribution between videos created by healthcare providers (blue) versus non-healthcare providers (orange). The second, or middle, ring shows the division and breakdown of content creators within the category of healthcare providers (blue) and non-healthcare providers (orange). Healthcare providers consist of both physicians and allied healthcare providers while non-healthcare providers did not have any further subdivision in this second ring. Lastly, the third, or outermost, ring shows further divisions among physicians, allied healthcare providers, and non-healthcare providers. Percentages are calculated out of a total of 723 analyzed TikTok videos. Each ring represents a hierarchy within the sunburst diagram. Eyecare providers include ophthalmologists and optometrists. All percentages are rounded to the nearest tenth

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Although the differences in mean engagement metrics were not significantly different based on ophthalmologist status (ophthalmologist vs. non-ophthalmologist), there was a significant increase in number of comments among content created by eyecare providers compared to non-eyecare providers (p < 0.05) and a significant increase across all engagement metrics (e.g., likes, comments, and bookmarks) among healthcare providers compared to non-healthcare providers (p < 0.05, p < 0.01, p < 0.05, respectively) (Fig. 2).

Fig. 2
figure 2

Differences in mean engagement metrics across content creators. This figure shows a bar graph that compares the average likes (blue), comments (orange), and bookmarks (gray) between the following three comparisons: (1) ophthalmologists and non-ophthalmologists, (2) eyecare providers and non-eyecare providers, and (3) healthcare providers and non-healthcare providers. The y-axis represents average likes, comments, or bookmarks. Error bars represent standard error means. * and **Represent statistical significance (p < 0.05 and p < 0.01, respectively)

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Video Content Type

A summary of the different video content categories is shown in Table 2 and Fig. 3. The majority of videos were primarily related to education (38%) and personal experience (35.8%) followed by entertainment (14%), patient experience (7.9%), and promotion (4.3%). Of the 408 videos (56.4%) containing any description of patient experiences, 22.8% exhibited a negative sentiment, 47.8% exhibited a neutral sentiment, and 29.4% exhibited a positive sentiment.

Fig. 3
figure 3

Distribution of content categories across 723 ophthalmology-related TikTok videos. Percentages are calculated out of a total of 723 analyzed TikTok videos. All percentages are rounded to the nearest tenth

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A Kruskal–Wallis H test was utilized to compare engagement metrics across primary content categories, which revealed statistically significant differences in likes (H = 30.0; p < 0.001), comments (H = 26.1; p < 0.001), and bookmarks (H = 49.7; p < 0.001) across the five primary content categories. The mean ranks for likes and comments were highest among patient experience videos (428.4 and 413.9, respectively) and lowest for promotional videos (275.6 and 293.7, respectively). Meanwhile, the mean ranks for bookmarks were highest among educational videos (422.1) and lowest among personal experience videos (303.6). PEMAT-A/V understandability and actionability scores were not significantly different across educational videos with and without mentions of patient experiences.

Content type was found to differ significantly across content creator status. A Mann–Whitney U test indicated that a greater quantity of videos featuring patient experiences were created by non-ophthalmologists compared to ophthalmologists (U = 15,009; p < 0.001). Additionally, the primary content category of a TikTok video significantly differed across ophthalmologist status with ophthalmologists more likely to create educational videos (60.7%) compared to non-ophthalmologists (33.4%) (U = 21,794; p < 0.001). Furthermore, non-ophthalmologists more commonly created videos related to personal experiences (42.6%) compared to ophthalmologists (2.5%). In terms of videos containing patient experiences, non-ophthalmologists were more likely to create videos with negative sentiment (25.1%) compared to ophthalmologists (0%). Similar findings were seen for eyecare providers and healthcare providers compared to non-eyecare providers and non-healthcare providers, respectively.

Educational Content and PEMAT-A/V Understandability and Actionability Scores

A summary of educational quality metrics is shown in Table 1. Of the primarily educational videos (38%), the average PEMAT-A/V understandability and actionability scores were 88.1% and 50.6%, respectively. Amongst hashtags, #Ophthalmology had the highest average understandability score (100%), while #Keratitis had the lowest average understandability score (64.5%). #PterygiumSurgery and #OrbitalCellulitis were tied for the highest average actionability score (100%), while #PRKSurgery and #StrabismusSurgery were tied for the lowest average actionability score (0%).

Interestingly, PEMAT-A/V actionability scores were significantly higher among videos created by non-ophthalmologists compared to ophthalmologists (U = 5824; p < 0.01) (Fig. 4). On the other hand, actionability scores did not significantly differ between eyecare providers and healthcare providers compared to non-eyecare providers and non-healthcare providers, respectively. Furthermore, PEMAT-A/V understandability scores were significantly higher among healthcare providers compared to non-healthcare providers (p < 0.01) and were higher among eyecare providers compared to non-eyecare providers (p < 0.01). However, understandability scores were not significantly different between ophthalmologists and non-ophthalmologists.

Fig. 4
figure 4

Average PEMAT-A/V understandability and actionability scores across content creators. This figure shows a bar graph that compares the average PEMAT-A/V understandability scores (orange) and average PEMAT-A/V actionability scores (blue) between the following three comparisons: (1) ophthalmologists and non-ophthalmologists, (2) eyecare providers and non-eyecare providers, and (3) healthcare providers and non-healthcare providers. The y-axis represents average PEMAT-A/V understandability scores or PEMAT-A/V actionability scores and indicates percentages (0—100%) on the PEMAT-A/V scale. Error bars represent standard error means. **Represents statistical significance (p < 0.01)

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Misinformation Presence

Among the total 723 videos, 5.4% (n = 39) contained misinformation, comprising 4.8% of likes, 4.7% of comments, and 11.7% of all bookmarks, which came from the following ophthalmology-related hashtags: #DryEyeSyndrome (n = 6), #LASIKSurgery (n = 4), #Conjunctivitis (n = 4), #LASIK (n = 3), #LaserEyeSurgery (n = 3), #Myopia (n = 3), #EyeSurgery (n = 2), #Glaucoma (n = 2), #DiabeticRetinopathy (n = 2), #AgeRelatedMacularDegeneration (n = 2), #EyeDisease (n = 1), #Cataract (n = 1), #Blepharoplasty (n = 1), #MacularDegeneration (n = 1), #CataractSurgery (n = 1), #PRKSurgery (n = 1), #Keratitis (n = 1), #Trabeculoplasty (n = 1). Of these videos, 74.4% were graded as having a significant amount of misinformation (i.e., more than half of each video contained misinformation), while 25.6% were graded as minimal (i.e., less than half of each video contained misinformation) (Table 3). Notably, all videos containing misinformation were created by non-ophthalmologists, and 87.2% were created by non-healthcare providers. The presence of misinformation differed significantly based on content creator status, with a greater incidence of misinformation found amongst videos created by non-ophthalmologists (U = 34,282; p < 0.01). When performing similar analyses amongst “eyecare providers” and “healthcare providers,” the incidence of misinformation was again found to be significantly higher amongst videos created by non-eyecare providers and non-healthcare providers, respectively (p < 0.001). Furthermore, misinformation status also differed significantly across primary content categories with the greatest amount of misinformation found amongst promotional videos and the lowest amongst videos related to patient experience (H = 16.4; p < 0.01).

Table 3 Characteristics of videos with misinformation
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Regarding engagement metrics, the number of bookmarks were significantly greater amongst videos with misinformation and was disproportionately higher (11.7%) than the total percentage of videos with misinformation (5.4%) (U = 9237.5; p = 0.001). There were no significant differences found amongst the number of likes and comments between videos with and without misinformation. Regarding educational quality metrics, PEMAT-A/V understandability scores were significantly higher among videos without misinformation (U = 1334.5; p < 0.001), and there was no difference in actionability scores.

Lastly, we performed an additional TikTok search in August 2023 for the top 20 most-liked videos within the #EyeHealth hashtag and found an even higher proportion of videos containing misinformation (15%) in this term compared to the overall average percentage of videos with misinformation in this study (5.4%).

TikTok Verification Status

Notably, there was an overwhelmingly greater amount of ophthalmology-related content produced by non-TikTok verified creators (93.4%) compared to TikTok verified creators (6.6%). Furthermore, TikTok verification status differed significantly between ophthalmologists and non-ophthalmologists (U = 34,456; p < 0.05). Specifically, TikTok verification status was significantly greater amongst non-ophthalmologists compared to ophthalmologists. This was also true for non-eyecare versus eyecare providers. Interestingly, TikTok verification status did not differ between healthcare providers and non-healthcare providers.

Compared to non-TikTok verification status, TikTok verification predicted a significantly greater number of likes (U = 9556; p < 0.001), comments (U = 11,169.5; p < 0.001), and bookmarks (U = 11,099.5; p < 0.001) as well as higher PEMAT-A/V understandability scores (U = 1432.5; p < 0.05), and actionability scores (U = 1346.5; p < 0.01). TikTok verification status did not significantly differ across primary content categories.

Discussion

Since the start of the COVID-19 pandemic, social media has become a salient source of both factual health-related information and disinformation [14]. To our knowledge, this study provides the first comprehensive overview of ophthalmologic content on TikTok with an emphasis on educational content and misinformation. Whereas previous studies focused on TikTok videos within the subfields of oculoplastics [15] and adolescent myopia [16], this present study analyzed ophthalmology-related content using a broad set of hashtags that span across the field of ophthalmology.

Our findings confirm that only a small minority of ophthalmologic TikTok videos are created by ophthalmologists (16.9%), while the majority is created by non-healthcare providers. These results are consistent with similar TikTok analyses done in other fields such as dermatology, where dermatologists were found to make up only 15.1% of all content creators [8].

Interestingly, compared to this TikTok study, a larger proportion of eye-related content was found to be created by ophthalmologists on Instagram (35.8%) based on a previous study using the same hashtags [10]. Another difference was that a smaller proportion of ophthalmology-related videos were educational on TikTok (38%) compared to Instagram (56.3%) [10]. This suggests that there is an underutilized opportunity for ophthalmologists to create educational content on TikTok. However, a major difference between TikTok and Instagram is that all content on TikTok is in the form of short videos, while the majority of ophthalmology content on Instagram is via static posts (82.2%) with only 8.8% being videos at the time of publication [10]. Thus, a greater amount of effort and time commitment is necessary to create TikTok content due to its video platform.

Furthermore, when comparing the results of this present study of comprehensive ophthalmic content on TikTok with content related to ophthalmic subtopics such as oculoplastics [15] and adolescent myopia [16], we noted that 16.3% of oculoplastic-related content was created by ophthalmologists/oculoplastic surgeons [15], and 45.8% of adolescent myopia-related content was created by medical professionals [16]. This is very similar to the proportion of ophthalmologists (16.9%) and healthcare professionals (45.0%) found in this present study. Furthermore, only 26.1% of oculoplastic-related content was educational or pertaining to a live surgery/procedure [15] while 38.0% of comprehensive ophthalmic content was educational in this study. Interestingly, there was a higher proportion of misinformation (10.1%) in the myopia TikTok study compared to this comprehensive ophthalmology study (5.4%), but the #Myopia hashtag also yielded one of the greatest numbers of videos with misinformation in this study.

Despite the relatively small presence of ophthalmologists on social media, our study showed that content from eyecare and healthcare providers garnered significantly greater engagement compared to non-eyecare and non-healthcare providers, respectively, on TikTok. Videos from healthcare providers were far more likely to receive likes, comments, and bookmarks compared to non-healthcare providers, suggesting that TikTok viewers may place greater trust and value in content created by healthcare providers. Thus, healthcare providers can use their expertise and credibility to share and disseminate ocular health education on TikTok more effectively. This is important since our study showed that ocular health-related videos containing misinformation (the majority of which were created by non-ophthalmologists/non-healthcare providers) were more likely to be bookmarked or saved for future reference.

Notably, about 5% of the most popular ophthalmologic TikTok videos (comprising 11.7% of bookmarks) were found to contain misinformation in our study. The majority of these videos came from terms related to the anterior segment of the eye, including #DryEyeSyndrome, #Conjunctivitis, and #LASIK. Additionally, the proportion of misinformation was found to be even higher (15%) under the more comprehensive #EyeHealth hashtag term. These findings underscore the need for ophthalmologists to create more evidence-based educational content around common eye conditions to counter the eye-related misinformation being widely spread on social media. Further studies characterizing misinformation amongst refractive surgery content, in particular, should be performed in greater detail.

In addition to creating a greater volume of evidence-based educational videos, another way to combat misinformation on social media is for ophthalmologists to create more engaging and higher quality educational content. While the most common type of videos created by ophthalmologists were educational in nature, our findings showed that the mean PEMAT-A/V actionability score of those videos was relatively low (50.6%). This was different from a recently published TikTok study focused on adolescent myopia where both understandability (84.7%) and actionability (74.9%) scores were relatively high [16]. Interestingly, our study showed that ophthalmologist-created videos yielded significantly lower actionability scores compared to non-ophthalmologists. This is similar to study findings in other fields including thyroid and skin cancer where PEMAT-A/V understanding scores were found to be high, but actionability was found to be low amongst physician-created videos [17, 18]. In contrast, greater average PEMAT-A/V actionability scores were found amongst COVID-19 videos created by medical professionals compared to non-medical professionals [19]. Thus, ophthalmologists have an opportunity to improve their eye-related social media content by incorporating more actionable steps that will allow viewers to apply that education to their health-related decision-making process. Hence, a “call to action” should be incorporated to encourage viewers to take deliberate steps to safeguard and/or improve their eye health.

In terms of engagement, educational videos were the most bookmarked, while videos showcasing primarily patient experiences yielded the highest number of likes and comments. Thus, ophthalmologists can consider incorporating patient stories whenever possible into their educational videos, while always maintaining patient privacy and HIPPAA compliance. Another option would be to adopt the popular “doctor reacts” format where medical professionals respond to patient-created TikTok videos in order to debunk false or dangerous health-related myths in an engaging and professional manner. However, we understand that content creation is time-consuming and requires an entire team including clinical staff, videographers, editors, and marketers. The creation of meaningful TikTok videos requires extensive time and energy that may be otherwise difficult for individual ophthalmologists. It should be noted, however, that engaging videos do not necessarily need to be of the “highest production” value in order to attract viewers as many “top performing” posts are filmed plainly with a smartphone.

One way to help viewers better assess the credibility of health-related content on social media would be to verify healthcare professionals’ accounts by designating vetted ones with a special symbol representing factual trustworthiness and expertise. Currently, the only designation employed by TikTok is a blue check mark next to one’s account name signifying “verified” status and is attained mainly through prominent media exposure rather than scientific credibility. However, TikTok verification status does provide the creator with a number of benefits including perceived credibility and greater exposure, which explains why engagement metrics were all significantly higher amongst creators who were verified by TikTok. Notably, only 1.6% of the ophthalmologists in this study were verified by TikTok. Repurposing of the verification status in the future could help healthcare professionals in the battle against misinformation on social media.

Limitations

A number of limitations exist. Content creator identities were determined via self-reported social media profiles and websites. Furthermore, the exclusion of non-English videos prevents the generalization of our findings globally. This study was also cross-sectional in nature and focuses on popular videos within a snapshot of time. Videos that are less popular may reveal differing trends and our observed trends may differ as time passes due to the dynamic nature of social media. Additionally, the search was limited to 37 hashtag terms and did not encompass all ophthalmology-related content on TikTok. Future replications can be expanded to include a greater variety of ophthalmology-related hashtag terms. Finally, the independent evaluation of the 37 hashtag terms and their associated TikTok videos were divided amongst two authors (RS and EGR), which can introduce inevitable observer bias. Due to the potential for observer bias in the PEMAT-A/V scoring, the authors generated the inclusion and exclusion criteria together and became well acquainted with the PEMAT-A/V tool prior to the evaluation of the videos in order to operationalize the definition of educational quality and to subsequently mitigate such bias.

Conclusions

Augmented by the COVID-19 pandemic, the transmission of online health information has grown exponentially, yet social media remains underutilized by ophthalmologists [20]. With over 3.8 billion TikTok views, our study shows that there is no shortage of public interest in ophthalmology, ocular surgery, and eye disease. There is a tremendous opportunity for ophthalmologists to create high-quality educational content on social media to promote patient education, while simultaneously combating misinformation.