Assessment of the Quality, Content, and Readability of Freely Available Online Information for Patients Regarding Diabetic Retinopathy | Diabetic Retinopathy | JAMA Ophthalmology | JAMA Network
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Original Investigation
August 22, 2019

Assessment of the Quality, Content, and Readability of Freely Available Online Information for Patients Regarding Diabetic Retinopathy

Author Affiliations
  • 1Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
  • 2Flaum Eye Institute, Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York
JAMA Ophthalmol. 2019;137(11):1240-1245. doi:10.1001/jamaophthalmol.2019.3116
Key Points

Question  What are the quality, accuracy, and readability of online information on diabetic retinopathy?

Findings  In this cross-sectional study, 11 diabetic retinopathy websites were analyzed. All were of poor quality and had a substantial variation in content accuracy and readability.

Meaning  These data suggest that available online information on diabetic retinopathy typically is not sufficient to support the patient in making appropriate medical decisions.


Importance  Diabetic retinopathy is a global leading cause of blindness. Patients increasingly use the internet to search for health-related information that may affect medical decision-making, but to date, no standard exists across published websites.

Objective  To assess the quality, content, and readability of information found online for diabetic retinopathy.

Design and Setting  This cross-sectional study analyzed 11 medical sites with information on diabetic retinopathy. Twenty-six questions were composed to include information most relevant to patients, and each website was independently evaluated by 1 vitreoretinal surgeon and 2 vitreoretinal fellows. Readability was analyzed using an online readability tool. The JAMA benchmarks were used to evaluate the quality of each site. Data were collected from December 2018 to January 2019 and analyzed in February 2019.

Main Outcomes and Measures  A 26-question survey, JAMA benchmarks, Flesch reading ease score, Flesch-Kincaid grade level, Gunning Fog Index, Coleman Liau Index, and Simple Measure of Gobbledygook Index.

Results  The mean (SD) questionnaire score for all websites was 55.76 (13.38) (95% CI, 47.85-63.67) of 104 possible points. There was a difference between the content quality of the websites (H = 25.811, P = .004). The mean (SD) reading grade for all websites was 11.30 (1.79; 95% CI, 10.24-12.36). No correlation was found between content accuracy and the mean reading grade (r = 0.445, P = .17) or Google rank (r = −0.260, P = .43). No website achieved the full 4 JAMA benchmarks, and only 1 website achieved 3 of the 4 JAMA benchmarks. No correlation was found between the accuracy of the content of the website and JAMA benchmarks (r = 0.422, P = .20). The interobserver reproducibility was similar among the 3 observers (r = 0.87 between observers 1 and 2, r = 0.83 between observers 1 and 3, and r = 0.84 between observers 2 and 3, P < .001).

Conclusions and Relevance  These findings suggest that freely available information online about diabetic retinopathy varies by source but is generally of low quality. The material presented seems difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide sufficient information using the grading scheme used to support the patient in making medical decisions.