LASIK Videos on TikTok: A Content Analysis of the Top 100 Videos

Introduction Social media has increasingly become a prominent source of health information. Platforms like TikTok that allow for videos to reach millions of viewers have become among the most common platforms to share and receive health information. Laser in situ keratomileusis (LASIK) videos and patients' experiences are commonly discussed on social media. The quality of these videos remains to be assessed. The aim of this study is to evaluate the content, quality, and reach of the top 100 videos related to LASIK eye surgery on TikTok. Methods Video quality was assessed using the DISCERN, JAMA, and GQS instruments which have all been proven to be both reliable and valid. Results 100 videos were included in the study. Results showed that the videos have an immense reach with a total view count of 245 million views and 21.9 million likes. Two thirds of the videos were posted by personal accounts as compared ophthalmologists that only constituted 26% of the content. Healthcare professionals produced higher quality videos compared to nonhealthcare professionals (p < 0.0001) although there was no significant difference in video duration (p=0.18). Increased duration, view count, comments, shares, saves, and views/day were all associated with increased DISCERN score and quality of the videos. Educational videos were of higher quality compared to entertainment videos, and videos outlining the procedure details had the highest quality score. Conclusions LASIK videos on TikTok have established a wide reach, whereby viewers are highly interacting and viewing these videos. It appeared that viewers interacted more with the higher quality videos. Ophthalmologists approximately only contributed to a quarter of the videos analyzed in this study. This highlights the need for ophthalmologists to establish a presence on TikTok and produce high quality videos.

Introduction.Social media has increasingly become a prominent source of health information.Platforms like TikTok that allow for videos to reach millions of viewers have become among the most common platforms to share and receive health information.Laser in situ keratomileusis (LASIK) videos and patients' experiences are commonly discussed on social media.Te quality of these videos remains to be assessed.Te aim of this study is to evaluate the content, quality, and reach of the top 100 videos related to LASIK eye surgery on TikTok.Methods.Video quality was assessed using the DISCERN, JAMA, and GQS instruments which have all been proven to be both reliable and valid.Results. 100 videos were included in the study.Results showed that the videos have an immense reach with a total view count of 245 million views and 21.9 million likes.Two thirds of the videos were posted by personal accounts as compared ophthalmologists that only constituted 26% of the content.Healthcare professionals produced higher quality videos compared to nonhealthcare professionals (p < 0.0001) although there was no signifcant diference in video duration (p � 0.18).Increased duration, view count, comments, shares, saves, and views/day were all associated with increased DISCERN score and quality of the videos.Educational videos were of higher quality compared to entertainment videos, and videos outlining the procedure details had the highest quality score.Conclusions.LASIK videos on TikTok have established a wide reach, whereby viewers are highly interacting and viewing these videos.It appeared that viewers interacted more with the higher quality videos.Ophthalmologists approximately only contributed to a quarter of the videos analyzed in this study.Tis highlights the need for ophthalmologists to establish a presence on TikTok and produce high quality videos.

Introduction
Social media is exponentially growing to integrate itself in the feld of healthcare.Its efciency and its ease of access in receiving information at the click of a few buttons have made it the frst resort for patients hoping to acquire information on medical conditions and procedures [1].However, the lack of regulation in social media platforms has allowed the spread of misinformation, which may be detrimental to the public.In recent years, healthcare workers have gradually resorted to social media to spread awareness, educate the general public, and debunk false information and myths spread online [2].
As the world's fastest growing online platform, TikTok has around 1 billion active users per month [3,4].Although it does not rank in the top three social media platforms, this can be due to the fact that it is among the youngest, established only in 2016.It initially attracted a younger demographic; however, it is now extending to all age groups and ranks among the fastest growing social media platforms [5].It has a personalized feature referred to as the "For You Page," which includes videos especially tailored for the viewer's likes and interests.Trough a simple interface, viewers can access hundreds and thousands of videos related to any topic of interest.Like other social media platforms, it has been used with the intent of spreading information, particularly healthrelated information.However, videos on TikTok are most commonly shared in 15 second, 1 minute, and 3 minute timeframes with exceptional videos extending beyond that.Tis sets a limitation on the amount of adequate knowledge that can be shared and explained in such a short time compared to other social media platforms.Tese limitations have not stopped patients from resorting to social media for health information.A study found that 75-80% acquired health information online [6].Tis emphasizes the need to assess the quality of the information shared on this platform to avoid the spread of misinformation and ensure proper education of the general public.
Laser in situ keratomileusis (LASIK) correction of refractive errors is among the most common procedures conducted by ophthalmologists worldwide [7].Tere are many misconceptions about LASIK spread on social media [8].Many of these misleading videos are shared by patient's individual experiences and are not evidence based.As such, it is essential to assess the quality of videos being published about LASIK, the type of content being produced, the characteristics of their content creator, and most importantly, the reach of these videos.
Te aim of this study is to analyze the top 100 videos related to LASIK on TikTok and to study the type of video, its creator's credentials, the content, the quality, and the reach.

Video Selection.
Te two most popular hashtags #lasik (622.1Mviews) and #lasiksurgery (62.0M) were used to extract the videos.Figure 1 outlines the video selection process.Videos were downloaded on May 1 st , 2023.All data extraction was done based on the downloaded videos to prevent new videos from emerging in the hashtag.

Data Extraction.
Te general information extracted included the duration of the video and the date the video was published on TikTok.Te number of days the video has been on TikTok was calculated by subtracting May 1 st , 2023 from the date the video was published online.Te views/day was calculated by dividing the total number of views of the video by the number of days the video has been available on TikTok.
Reach of the video was assessed via the total number of views, likes, comments, shares, and number of saves of the video.Te content creator was evaluated by extracting the number of account followers, TikTok certifcation, and the content creator category (ophthalmologist, nonophthalmology doctor, optometrist, nurse, resident/student, personal account, brand, or organization).In regards to the type of video, videos were considered either procedure details, comedy, patient experience, Question and Answer (Q&A), case discussion, or negative patient experience.Te purpose of the video was categorized as either educational or for entertainment purposes.Ten, a yes/no input was extracted for whether the video mentioned LASIK surgery details, specifc LASIK techniques, visual outcomes and satisfaction, use of visual aids, or risks of LASIK.

Video Quality.
Video quality was assessed by using three international valid and reliable scoring systems for health information on the internet.Te frst, the DISCERN scoring instrument, consists of 15 questions each graded between 1 and 5.A total score is then divided by 15 to get an average score between 1 and 5, refecting the quality of the video.Te instrument looks at the video's relevance and currency, its bias and subjectivity, whether it discusses the range of treatment choices and their risks/benefts, and whether it discusses decision-making and future projections of the treatment choice [9].Te second tool used was the JAMA score.It consists of 4 items each receiving a score of either 0 or 1 to calculate a total score out of 4. Te score looks at the following 4 criteria: authorship, attribution, disclosures, and currency [10].Te third score was the GQS (Global Quality Scale).It consists of a scale of 5 points, with increasing points indicating higher quality, better fow, and more relevant information presented with little bias [10].Higher scores in all three scales refect a higher quality of video, and all three scoring systems have been used in the literature to quantify the quality of health information videos.

Data Analysis. Data analysis was conducted on
Microsoft Excel and SPSS.Te means, standard deviations, median, and interquartile ranges of the diferent reach parameters were calculated on Excel.Correlation coefcients and their p values were calculated on SPSS.Te Kruskall-Wallis test was used to test the diference in mean DISCERN scores against diferent parameters.

Results
One-hundred videos were included in the study with a total of 245,173,500 views, 21,911,733 likes, 214,608 comments, 748,326 shares, and 1,036,173 saves.Table 1 outlines the average of diferent data parameters of the videos included.
Forty-two videos (42.0%) were posted by small accounts with a follower count <50,000; 21 videos (21%) were posted by medium sized accounts (50,000-200,000); and 37 videos  Journal of Ophthalmology (37%) were posted by large accounts (>200,000).Seventeen percent of videos (n � 17) were posted by accounts that are TikTok certifed, while the remaining did not have such verifcation.Figure 2 outlines the distribution of videos among the diferent content creator types.Seventy-four percent were educational videos while 26% were entertainment videos.Twenty-eight percent mentioned LASIK procedure steps, 25% mentioned visual outcomes and satisfaction, 15% mentioned specifc LASIK techniques, 15% mentioned the risks and complications associated with LASIK, and 8% used visual aids in the videos.Figure 3 outlines the video distribution among the diferent video types.
Table 2 shows the correlation between the 3 scoring systems and diferent parameters related to the reach of the videos.
Te r correlation coefcient presented in Table 2 range between 0.10 and 0.30, indicating a modest positive correlation, and some of the parameters have signifcant correlation coefcients while others did not.Increased duration, view count, comments, shares, saves, and views/day were associated with increased DISCERN score and quality of the videos.Increased view count, shares, and saves were associated with the increased JAMA score.Increased duration, view count, comments, shares, and saves were associated with the increased GQS score.Tis indicates that the longer the video is, the better quality the video was rated in both the DISCERN and GQS scores.Te average video length produced by healthcare professionals (ophthalmologist, nonophthalmologist doctor, and optometrists) was 37.18 ± 18.44 seconds whereas the average video duration produced by nonhealthcare professionals was 48.47 ± 42.14 seconds (p � 0.18).Higher quality videos were viewed, commented on, shared, and saved more than their lower quality counterpart, which indicates that viewers were enjoying higher quality videos rather than the lower quality ones.Table 3 presents the DISCERN score of the videos grouped by account size, creator type, type of video, and purpose of video.

Discussion
Social media has increasingly become a source of health information for the public due to its low cost, efciency, and simplicity [1].TikTok is among the most prominent platforms to share and receive health-related knowledge due to the high reach these videos get compared to other platforms [2].Our study highlights a signifcant reach for LASIK-related videos on the platform with a total view around 250 million views and an average of 2.5 million views/video.Our study also highlights that TikTok videos about LASIK are still of poor quality.With an average DISCERN score of 1.67/5, the videos are still poor in quality and have major shortcomings.With that in mind, ophthalmologists should ride the wave and resort to TikTok to spread educational videos related to LASIK eye surgery.In our cohort, only 26% of videos were posted by ophthalmologists.
In addition, healthcare professionals created the videos with the highest quality, which further emphasizes the need for doctors in general to increase their presence on the platform due to their ability to create unbiased and high    Te duration, number of views, shares, saves, comments, and views/day all had a moderate correlation with DISCERN quality.Tis indicates that viewers were interacting with high quality videos more than their lower quality counterparts.Tis fnding has been reported in other studies as well [11].Te duration, number of views, shares, saves, and comments were all moderately correlated with GQS quality.Te JAMA score did not highlight the same association.It may be due to the limited and simpler nature of the scoring system.Te JAMA score consists of 4 yes/no questions as compared to 15 scaled questions in the DISCERN scoring instrument.In addition, the JAMA tool addresses more specifc questions pertaining to the authorship, attribution, disclosure, and currency of the video, whereas the GQS is more of a broad scaling from 1 to 5 of the quality of the video.
Medium-sized accounts had the tendency to produce the highest quality videos.Videos outlining procedure details had the highest quality, possibly because these videos were exclusively published by healthcare professionals who are the most knowledgeable in the feld.Comedy and negative patient experiences had the lowest quality.Comedy videos produced for entertainment purposes were of low quality in the present study; an expected fnding since the purpose of the video is for entertainment rather than to educate the general public.It would be interesting for future studies to assess whether comedy videos that are educational and contain informative content perform superiorly to both comedy videos for entrainment purposes or educational material lacking comedy.Negative patient experience videos were created mostly by personal accounts, resulting in their lower quality.As such, there is a need for ophthalmologists to address the risks of LASIK eye surgery in a nonbiased manner to prevent the spread of misinformation created by low quality videos of negative patient experiences.
Diferent studies assessing the use of TikTok in their respective felds have reached results similar to ours [12,13].A study by Siegal et al. on TikTok videos about varicoceles found that healthcare professionals published signifcantly better videos than their nonhealthcare counterparts [14].A study by Dubin et al. on men's health information on TikTok established the huge reach health information videos have on TikTok and that the video quality was poor and published mostly by nonhealthcare professionals [15].A study by Chen et al. found a similar correlation between the duration of the video and the video quality (DISCERN and GQS), confrming that high quality videos tended to be of longer duration, as reported in this present study [16].
Te assessment of the misinformation on social media has been studied before.A study published in 2021 found that the most common topics with misinformation on social media were vaccines, drugs/smoking, noncommunicable diseases, medical treatment, and pandemics.Te study showed that 30% of the included posts related to medical treatments contained misinformation.Tis number can rise up to 87% in posts related to smoking and drug use [17].Another study published in 2022 assessed a similar topic.Te study included no studies related to misinformation on TikTok, which emphasizes the need for further studies to assess the quality of health information on this platform.Te study reported a very sharp increase in publication and citation count on papers related to misinformation on social media, highlighting the acknowledgement of the infuence of social media platforms on awareness and health information [18].
Our study is not without its limitations.First, the study is a cross-sectional study and thus causal relationship cannot be established.Second, only videos done in the English language were included which limits out ability to generalize our results worldwide.Lastly, the sample size was limited to 100 videos.Other studies are encouraged to analyze videos with a greater sample size.

Conclusion
Our study highlights that although TikTok videos regarding LASIK have a very wide reach, they are mostly of poor quality.With better knowledge, ophthalmologists are urged to produce more videos since they only constitute 26% of the top videos.Te results show that viewers were interacting and viewing better quality content.One prominent issue to address is the negative patient experiences.Such videos were numerous and were of very poor quality.As such, ophthalmologists should counter the efects of these videos by objectively discussing the risks and complications of LASIK eye surgery.

Figure 1 :
Figure 1: Video selection and the inclusion fowchart.

Figure 2 :Figure 3 :
Figure 2: Video distribution by the creator type.

Table 1 :
Average, standard deviation, range, and median (IQR) of parameters related to the reach of the videos.

Table 2 :
Correlation between the three scoring systems and the reach of the videos.

Table 3 :
DISCERN score by account size, creator type, type of video, and purpose of video.