Assessment of the readability and quality of online patient education materials for the medical treatment of open-angle glaucoma

Objective Patient adherence to glaucoma medications is poor, and is linked to low literacy levels. Patients commonly use the internet to access health information, and it is recommended that patient information is written at an 11-year-old reading level. The aim of this study is to assess the readability and quality of online patient education materials for the medical management of open angle glaucoma. Methods and analysis The top 10 relevant Google searches for nine glaucoma medications (timolol, brimonidine, apraclonidine, dorzolamide, latanoprost, birnatoprost, travoprost, tafluprost and brinzolarnide) and three generic searches were analysed for readability and accountability. Readability was assessed using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI) and Simple Measure of Gobbledygook Index (SMOG). Webpages were classified by source and assessed using Journal of the American Medical Association (JAMA) benchmarks of accountability. Results 111 articles were included in the analysis. Mean readability scores were: FRES 55.5 (95% Cl 53.4 to 57.5); FKGL 9.7 (95% CI 9.3 to 10.0); GFI 12 (95% CI 11.6 to 12.4) and SMOG 9.3 (95% Cl 8.9 to 9.6). One-way analysis of variance demonstrated no significant difference in readability score between source type. 9% of the webpages satisfied all 4 JAMA benchmarks. Pearson's correlation coefficient showed a correlation between the FRES and accountability score (r=0.19, p=0.045). Conclusion The majority of online patient education materials for the medical treatment of glaucoma are written at a level too difficult for the general population and fail to meet accountability standards.