Ophthalmic health communication in the video-based social media era: A narrative review of information quality,engagement dynamics,and professional education

2.1. Review design

This review was designed as a structured narrative review. The objective was not to estimate pooled effects or formally grade the certainty of evidence, but to synthesize empirical literature on ophthalmology-related video-based social media content and to identify recurring themes related to information quality, engagement dynamics, misinformation risk, ethical considerations, and professional education. “Short-form video” refers specifically to ultra-brief, algorithmically-curated visual content (typically under 60–180 seconds) optimized for mobile consumption on platforms such as TikTok or YouTube Shorts, distinguished from traditional long-form educational tutorials by its emphasis on rapid engagement and fragmented messaging. We use the terms “patient-facing education” and “professional-facing education” to distinguish between content primarily intended for patients or caregivers and content intended for ophthalmologists, trainees, or other eye-care professionals.

2.2. Search strategy and study selection

We searched PubMed and Web of Science Core Collection for empirical studies evaluating ophthalmology-related content on video-based social media platforms. The search combined ophthalmology-related terms with platform- and video-related terms, together with terms related to misinformation, information quality, reliability, accuracy, and commonly used assessment instruments. The full search strategy is provided in Supplementary Material 1.

Studies were eligible if they met the following criteria: (1) empirical evaluation of ophthalmology- or eye health-related content; (2) assessment of video-based social media platforms, including YouTube, TikTok, Instagram, Bilibili, Kwai, Douyin, YouTube Shorts, or Instagram Reels; and (3) reporting of at least one structured assessment related to information quality, reliability, accuracy, educational value, misinformation, content characteristics, uploader source, or engagement metrics. Studies were excluded if they were not ophthalmology-related, did not evaluate video-based social media content, lacked an empirical assessment framework, were commentaries or purely conceptual articles, or were unavailable in full text.

The search retrieved 141 records from PubMed and 280 records from Web of Science. After cross-database deduplication by article title, 377 unique records remained. Title and abstract screening was performed independently by two reviewers according to the predefined eligibility criteria. Records considered potentially eligible by either reviewer were retained for full-text assessment. Full-text assessment was also performed by two reviewers, and disagreements were resolved through discussion; unresolved discrepancies were adjudicated by a third senior reviewer. Title and abstract screening retained 84 studies for full-text assessment. During full-text retrieval, eight otherwise eligible studies were unavailable and were excluded. The final synthesis included 76 studies (Figure 1).OPEN IN VIEWER

For each included study, data extraction was performed using a predefined extraction form. We extracted publication year, first author, platform, ophthalmic subspecialty or topic area, number of videos assessed, uploader or source categories when available, evaluation instruments, quality or reliability outcomes, engagement metrics, and main findings relevant to health communication or education. One reviewer performed the initial extraction, and a second reviewer checked the extracted data for accuracy and completeness. Discrepancies or uncertain items were resolved through discussion. Extracted information was summarized in evidence-mapping tables, including the characteristics of included studies, the distribution of studies across platforms and ophthalmic topic groups, and the frequency of evaluation instruments.

Final themes were generated through an iterative narrative synthesis process. After data extraction, the included studies were grouped by platform type, ophthalmic topic, target audience, and assessment focus. Recurring findings were then compared across studies to identify cross-cutting concepts, including information quality, source effects, engagement–quality mismatch, commercialization, misinformation risk, privacy and consent, professional education, and methodological limitations of existing assessment tools. These concepts were discussed among the review team and consolidated into the final narrative themes. Themes were retained when they were supported by multiple included studies or when they represented clinically important emerging issues in ophthalmic digital communication.

2.3. Structured descriptive appraisal of the evidence base

Given the narrative-review design and the methodological heterogeneity of the included studies, we did not apply a formal risk-of-bias tool or certainty-of-evidence framework. Most included studies were cross-sectional content analyses of publicly available videos and differed in platform, search strategy, sampling approach, scoring instrument, and engagement metrics, which limited the applicability of a single standardized appraisal tool.

Instead, we conducted a structured descriptive appraisal to contextualize the strength of the evidence base. This appraisal was based on the information available from the included studies and the evidence-mapping tables. Specifically, we considered the number of studies supporting each major theme, platform and ophthalmic topic coverage, approximate sample size reflected by the number of videos assessed, use of established or commonly used evaluation instruments, and the consistency of findings across studies. Platform and topic coverage were summarized in Table 1, evaluation instruments were summarized in Table 2, and study-level characteristics, including platform, subspecialty, number of videos, and assessment tools, were summarized in Table S1. This approach was used to guide the interpretation of narrative conclusions and to avoid presenting platform-specific, heterogeneous, or cross-sectional findings as definitive causal evidence.

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Table 1.

Distribution of included studies across platforms and ophthalmic topic groups.

Subspecialty group	YouTube	TikTok	Instagram	Bilibili	Kwai	Total
Cornea/Refractive	17	7	0	1	1	26
Retina	14	1	1	0	0	16
General/Other	8	4	0	0	0	12
Pediatric/Strabismus	3	4	2	1	0	10
Orbit/Oculoplastics	3	2	0	1	0	6
Glaucoma	4	0	0	0	0	4
Uveitis/Ocular inflammation	3	1	0	0	0	4
Cataract	1	1	0	0	0	2
Oncology	1	0	0	0	0	1
Total	54	20	3	3	1	81

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Table 2.

Frequency of evaluation instruments used across included studies.

Instrument	Studies (n)	Studies (%)
DISCERN	66	86.84
GQS	53	69.74
JAMA benchmarks	44	57.89
PEMAT-A/V	14	18.42
HONcode	8	10.53
EQIP	3	3.95
VIQI	1	1.32
mMICI	2	2.63
Usefulness score/index	4	5.26
Other/Custom instruments *	14	18.42

*Other/Custom instruments includes study-specific or platform-specific measures (e.g., VPI/VQS, content coverage/comprehensiveness scores, CRAP/CRAAP rubrics, author-defined classification systems).

DISCERN = DISCERN (quality criteria for consumer health information on treatment choices); GQS = Global Quality Score; JAMA = Journal of the American Medical Association; PEMAT-A/V = Patient Education Materials Assessment Tool for Audiovisual Materials; HONcode = Health On the Net code; EQIP = Ensuring Quality Information for Patients; VIQI = Video Information and Quality Index; mMICI = modified Medical Information and Content Index.

3.1. Common chronic conditions and lifestyle-oriented content: The tension between high traffic and commercialization

Content on myopia, dry eye disease, and thyroid eye disease frequently becomes highly visible on short-form platforms, particularly when it can be framed as daily-life advice and quick self-management tips.^9,15 This visibility is not accidental. These topics are easy to package into short clips that match the attention patterns of algorithm-driven feeds. ¹⁶ As a result, users are repeatedly exposed to symptom checklists, home care routines, product recommendations, and simplified “do and do not” messages that require little background knowledge to understand. ¹⁷

Across studies that assessed ophthalmic videos using established scoring systems, a recurrent pattern is content polarization by uploader type. Health care professionals and institutional accounts more often adopt an educational approach that covers basic definitions, common symptoms, and guideline-consistent management options. In myopia-focused content, clinician-produced videos are more likely to describe risk factors and prevention strategies in a structured way. ¹¹ In contrast, videos produced by non-professional creators or accounts with commercial incentives more often emphasize “vision training,” device-based interventions, or product-centered narratives.^18,19 These videos can be compelling and highly shareable, but they often provide limited scientific justification and less balanced discussion of uncertainty and contraindications. For dry eye disease, YouTube-based analyses suggest that even when videos are frequently produced by clinicians, the content tends to emphasize symptoms and general management more than diagnostic standards, differential diagnosis, and escalation thresholds. ²⁰

Overall, available studies generally portray information quality in these lifestyle-oriented areas as modest and inconsistent, with short-form platforms amplifying content that is easy to consume rather than content that is complete. This creates an environment in which users can receive frequent exposure to plausible recommendations, but still remain under-informed about diagnostic framing and evidence hierarchy. ¹⁴

3.2. Surgical and interventional content: Expectation management and the appeal of visual demonstration

Surgical topics such as refractive procedures, cataract surgery, retinal detachment surgery, vitrectomy-related care, and keratoconus interventions are strongly driven by the visual nature of ophthalmology. Video is uniquely well-suited to demonstrate operative steps, show anatomical concepts, and illustrate postoperative experiences. ² Consequently, YouTube remains a primary venue for longer procedural explanations and for content that resembles a tutorial. At the same time, short-form platforms increasingly host patient experience narratives, particularly for elective procedures such as LASIK-related surgery, where the emotional arc of decision-making and early recovery fits well with short clips and personal storytelling.^21,22

Despite the abundance of videos, several disease-specific analyses reported similar limitations in patient-facing surgical education. Many videos are rated as low quality or low utility when judged against tools that emphasize balanced discussion of indications, alternatives, risks, and expected outcomes. This concern appears in studies of cataract surgery videos, retinal detachment surgery videos, and other procedure-focused materials.^23–25 A common weakness is incomplete expectation management. Videos may highlight “success stories,” technical visuals, or simplified claims of rapid recovery, while devoting less attention to contraindications, variability in outcomes, realistic timelines, and the trade-offs that matter most to patients.

The literature also suggests that professional perspective and patient perspective contribute different strengths and different blind spots. Clinician-produced videos tend to perform better when assessments prioritize accuracy, procedural detail, and risk disclosure. ²² However, these videos can become overly technical and may not address practical concerns that patients often prioritize, including daily functioning, fear and uncertainty, recovery milestones, and how to interpret postoperative symptoms. Patient-produced videos often fill this gap by providing lived experience and peer support, but they can unintentionally generalize from individual outcomes or normalize marketing narratives, especially when content is sponsored or closely linked to commercial branding. ²⁶ Together, these studies indicate that surgical content is plentiful but uneven, and that the most visible videos do not consistently deliver comprehensive counseling that supports informed consent and realistic expectations.^25,27

3.3. Content for vulnerable groups and caregiver audiences: Emotional resonance and heightened risk of misinformation

A distinct content ecology emerges in pediatric ophthalmology and in chronic conditions that require long-term follow-up, where the primary audience is often anxious caregivers or patients facing sustained uncertainty. Studies examining social media content on strabismus, amblyopia, retinopathy of prematurity, and childhood glaucoma commonly reported a related structural issue.^28–30 High emotional stakes increase engagement, and engagement-friendly narratives may crowd out careful clinical framing. This is especially relevant when families seek quick answers about prognosis, developmental outcomes, and whether non-surgical interventions can substitute for professional care.

Within this space, misinformation risk is repeatedly observed in content that promotes unverified vision therapy or broad claims about visual training for learning or developmental problems. ³¹ Such claims are frequently disseminated by non-specialists and are presented with high confidence, simple success stories, and appealing before-and-after narratives. Several analyses also highlight that high-quality clinician videos can receive lower engagement than experiential content, which suggests that caregiver audiences may not be systematically guided toward the most reliable material.^28,32 These observations suggest a clinically important mismatch between medically responsible communication and algorithmically rewarded content.

At the same time, the literature emphasizes that social media is not only an information source. ² It is also a space for emotional processing and community building. In at least one TikTok analysis of strabismus-related content, patient experience posts represented more than half of the videos, which underscores the importance of peer narratives in shaping perceptions of stigma, treatment burden, and recovery.^32,33 This community function can be valuable, but it also increases the need for credible guidance that helps caregivers interpret stories without mistaking them for general medical advice. For complex conditions such as retinopathy of prematurity, YouTube-based evaluations suggest that available videos are often insufficient in quality and structure to meet parental needs.^30,34 This gap suggests an important role for academic institutions and professional societies to provide caregiver-oriented materials that are both emotionally sensitive and clinically rigorous, with explicit guidance on urgency, follow-up, and red-flag symptoms.

4.1. Source effects and the displacement of trust

Across ophthalmic topics, uploader source remains one of the most consistent correlates of informational quality. Videos produced by health care professionals, academic institutions, and non-profit organizations more often present clinically structured education, including clearer definitions, more balanced discussion of management options, and stronger alignment with evidence-based recommendations. ³⁵ However, source credibility does not invariably guarantee content exhaustiveness.^36,37 Even professional videos may foreground symptoms and general advice while giving limited attention to diagnostic thresholds, uncertainty, contraindications, and when escalation to in-person assessment is warranted.^28,38

We interpret the prominence of patient narratives and influencer-led content as a potential form of trust displacement, in which viewers may rely more on perceived authenticity than on traditional medical authority. ³⁹ Patient influencers and experience-based creators can be perceived as more authentic because their stories resemble the viewer’s own concerns. This dynamic is particularly visible in ophthalmology, where stigma, appearance-related anxiety, and fear of irreversible vision loss can make narrative medicine a powerful credibility currency.^32,40 Empirically, this “trust displacement” aligns with observations that patient experience posts dominate parts of pediatric ophthalmology and strabismus-related content, while non-professional advice also circulates widely in myopia prevention discussions. ²⁸ These narratives can provide community support and reduce isolation, but they can also generalize individual outcomes into implicit guidance and amplify misinformation risk when clinical context is missing.

4.2. The engagement paradox and platform-driven simplification

A second recurring observation is the engagement–quality mismatch, which we refer to as the “engagement paradox.” Several platform-specific evaluations reported that views, likes, comments, and shares did not consistently correspond to educational quality, and some studies observed inverse associations in specific contexts. ²⁷ This preferential propagation may reflect platform-level incentives rather than random variation. Recommendation systems may reward watch time and emotional response, which is consistent with the observed misalignment between popularity and educational quality.^41,42

This mechanism has distinct ophthalmic specificity. Eye care is unusually “visual-first,” and short video ecosystems are primed to amplify visual symbols that suggest immediacy and certainty. Examples that repeatedly appear in platform content include refractive surgery clips that imply instant transformation after LASIK or SMILE, and highly shareable procedural visuals used in chronic symptom management. ⁴² These formats can create an impression of simple solutions while downplaying surgical risk trade-offs, variability in outcomes, or the long time horizon of chronic disease management.

Short-form constraints further intensify distortion. Many ophthalmic conditions rely on anatomy and pathophysiology to explain risk and to guide safe decisions, for example, glaucoma mechanisms, ⁴³ corneal biomechanics ²⁵ in keratoconus, ²² or long-term behavioral drivers in myopia control. ⁹ These concepts compete poorly in fragmented videos that prioritize a single takeaway, a single product, or a single personal story. As a result, content may default to oversimplified heuristics that are easier to watch but harder to translate into safe care-seeking behavior.

4.3. Platform architecture, ecosystem differences, and cultural context

Differences in ophthalmic video quality across platforms may partly reflect platform architecture. Short-form, feed-driven platforms such as TikTok and Kwai emphasize rapid viewing, emotional response, and algorithmic recommendation.^44,45 These features can improve reach and accessibility, but they may also compress clinical reasoning into simplified messages and amplify visually striking, emotionally resonant, or product-centered claims. ⁴⁶ In ophthalmology, this is particularly relevant because procedural images, visible symptoms, and before-and-after narratives can appear persuasive even when clinical context is incomplete.^9,14 By contrast, YouTube functions more as a searchable long-form archive, allowing more detailed explanations, procedural demonstrations, and professional-facing surgical learning. ⁴⁷ However, longer format does not ensure higher quality, because YouTube videos may still contain commercial intent, selective case presentation, outdated information, or insufficient discussion of risks and contraindications. ⁴⁸

Cultural and regional differences should also be considered. Chinese platforms such as Bilibili, Douyin, and Kwai operate within media ecosystems, user communities, and public-health priorities that differ from those of Western platforms. Comparative digital health communication research has shown that visual health discourse may vary across countries, languages, and platform environments, supporting the need to interpret online health content within its cultural and media context. In China, myopia prevention and child eye health have become prominent public-health priorities, reflected in national eye health plans and multi-sectoral policies targeting childhood and adolescent myopia.^49,50 This context may partly explain why myopia prevention and child vision care receive substantial attention in Chinese short-video environments. Recent studies of Chinese platforms have specifically evaluated myopia-related videos on TikTok, Bilibili, and Kwai, and reported suboptimal or variable information quality despite high public-health relevance.^9,11 Because current evidence remains uneven across platforms, diseases, and cultural settings, future studies should use platform-specific and culturally contextualized evaluation frameworks rather than assuming that findings from YouTube or Western TikTok can be directly generalized to Chinese video platforms. ⁵¹

4.4. Covert commercial intent and source signaling as practical levers

Covert commercial intent is an under-addressed driver of both engagement and misinformation risk.^52,53 In several high-interest ophthalmic areas, particularly elective procedures and chronic symptom markets, videos that appear educational may function as indirect marketing for clinics, devices, or service packages, while conflicts of interest are not consistently disclosed. ⁵² This blurs the boundary between education and promotion and can mislead viewers who interpret confident delivery and professional aesthetics as clinical endorsement.

In this environment, source signaling becomes a practical lever for harm reduction. Clear credential disclosure, transparent conflict-of-interest statements, and institution-linked provenance can help viewers interpret content more appropriately. ⁵⁴ Yet source signaling alone is insufficient if high-quality videos remain less discoverable than sensational content. ⁵⁵ These observations suggest a dual strategy. The first is to improve the completeness and actionability of professional content without sacrificing accessibility and narrative connection. The second is to strengthen platform and professional standards for disclosure and labeling, particularly for commercially adjacent ophthalmic content, so that users are not forced to infer credibility from popularity cues that are poorly aligned with medical quality. ⁵²

4.5. The ethical dimension: Patient privacy and digital consent

The visual-first nature of ophthalmology introduces unique ethical challenges regarding patient privacy. ¹⁰ Unlike other specialties where cases can be easily de-identified, ocular conditions often involve recognizable facial features (e.g., strabismus, ptosis) that make complete anonymization difficult.^56,57 This raises critical concerns about informed consent, particularly for vulnerable populations such as pediatric patients, whose images may be permanently archived on social platforms without their future agency in mind. ⁵⁸ Furthermore, the commercial incentive to showcase dramatic “before-and-after” results can inadvertently prioritize engagement over dignity. ⁵⁴ Consequently, current ethical frameworks may need to evolve to better address the permanence and limited controllability of algorithmic distribution.