Online patient education materials on myopia in Australia and Canada often overshoot recommended readability levels, according to new research – but clinicians said the issue is more nuanced when communicating complex eye health concepts.

The study, published in Investigative Ophthalmology and Visual Science,1 assessed the top 10 Google search results from May 2024 for freely available patient information on myopia management and myopia products.

Searches were conducted in Canada and Australia, but websites could be based in any country.

Researchers analysed 120 English language websites covering treatments such as orthokeratology, spectacle lenses, soft contact lenses, and atropine, as well as related products. Readability was measured using multiple indices, alongside quality assessment using Journal of the American Medical Association (JAMA) benchmarks.

None of the websites met the recommended sixth grade reading level across all readability measures. Only 13 met at least one index, 10 being product-related; and just seven – all from one professional organisation – met all four JAMA quality benchmarks.

The study authors concluded that many materials require higher reading skills than recommended, potentially limiting accessibility for some patients. They noted that improving readability could support better patient understanding and outcomes.

BALANCING READABILITY WITH CLINICAL ACCURACY

However, clinicians working in myopia management caution that strict adherence to simplified readability targets may come at a cost.

Dr Kate Gifford, co-founder and Lead Educator at Myopia Profile and MyKidsVision.org – one of the most visible platforms identified in the study – said readability must be balanced with clinical accuracy.

“Readability of patient-facing materials is genuinely important, and we take it seriously,” she said. “However, having worked through these guidelines in practice, we have real concerns about whether a strict sixth-grade standard is appropriate for content that introduces parents to a specialist clinical field.”

Dr Gifford said attempts to meet the criteria can reduce essential clinical meaning.

“Since this paper was released, we have experimented with rewriting some of our most popular articles to meet the criteria. The results were shorter sentences, but also the loss of essential clinical meaning.”

She said the removal of key terms and qualifiers is particularly problematic.

“Terms like ‘axial length’, conditions like macular degeneration and glaucoma, and carefully qualified language such as ‘in most cases’ or ‘potentially’ are all eliminated.”

“That last point matters most, as removing clinical nuance from health information can be actively misleading for parents making treatment decisions for their children.”

Dr Gifford also noted that audience context is critical when determining appropriate readability levels.

“MyKidsVision’s audience consists of parents who have actively sought out specialist information about their child’s eye condition: they are motivated, engaged, and perhaps already partway into a clinical conversation.

“Applying a lowest-common-denominator standard to content that must accurately introduce specialist clinical concepts is, we would argue, not an ideal fit.”

The study itself noted that the average adult reads at approximately an eighth-grade level, and that using this threshold significantly improved compliance among the websites assessed.

It also acknowledged that readability formulas do not account for necessary medical terminology – a key limitation when evaluating specialist health content.

Dr Gifford emphasised the role of clinician-authored content in bridging this gap.

“All MyKidsVision articles are written and reviewed by at least two clinicians experienced in explaining these concepts to patients.

“That clinical authorship is what allows us to introduce terms like ‘axial length’ or ‘orthokeratology’ while simultaneously explaining what they mean, which the rewritten versions struggle to do.”

Dr Gifford welcomed continued discussion on improving health literacy, but cautioned against a one-size-fits-all approach.

“We welcome the broader conversation about improving public awareness and health literacy in myopia management.

“We’re just not convinced that applying this standard to a specialist clinical field – aiming to improve literacy around terminology as well as the condition – serves parents better than the approach we currently take.”

Despite the readability findings, the study highlighted the strong visibility of MyKidsVision, which ranked highly across multiple treatment-related searches – it was the top ranked search appearance in each of the treatment modalities.

Reference
1. Jong M, Waugh M, Ozmizrak P, Flitcroft I. Readability of online patient education materials for myopia management. Ophthalmic Physiol Opt. 2026 Mar 16. doi: 10.1007/s44402-026-00030-6.