All Eyes on Ophthalmology: Spreading Awareness through Social Media

With 2.5 billion daily active users worldwide (and revenues expected to reach over $23 billion by 2024), it is hard to believe that TikTok – and its Chinese counterpart Douyin – was only founded in 2016 (1). Catering to the modern, busy individual (or anyone with an attention span measured in seconds rather than minutes), the social media app allows its users to upload and watch short videos. Originally showcasing dance videos and comedy sketches, the platform now helps share information, market products, and promote services.

And the clinical field is not immune to its allure; patients actively seek advice on TikTok and other social media platforms, creating a space for medical professionals, including ophthalmologists, to carve a new niche. You may have already stumbled upon catchy videos, such as “5 things I would NEVER do as an ophthalmologist” (spoiler alert: “I wouldn’t miss out on having LASIK” is number 3) and “Eye myths busted,” which can garner hundreds of thousands of views (2,3). On the face of it, TikTok represents a new way for people to gain access to quick-fire information in an increasingly digital age (and in a world where gaining access to quality ophthalmic care may be difficult or require long waiting periods).

But where there is light, there is also dark – and the misuse of social media can lead to serious consequences. Alongside issues around patient confidentiality and professional boundaries, social media can sometimes blur the distinction between medical education and personalized medical advice that presents patients with incomplete assessments not tailored to their specific cases (4).

In this article, we speak to four ophthalmic influencers, all of whom have large social media followings: Dagny Zhu, Brain Boxer Wachler, Rupa Wong, and Vicki Chan. Collectively, they discuss the pros and cons of using social media for disseminating information, the potential conflicts of interest when discussing eye disease, and the issue of medical misinformation.

What initially inspired you to share ophthalmic information on social media platforms?
 

Dagny Zhu: I created my first public social media account (Instagram) shortly after graduating from fellowship and starting my first job in private practice. It was a way for me to introduce myself as a practicing eye surgeon and share all the life-changing surgeries and advanced technologies we have today to help our patients see better. It allowed me to not only grow my practice, but also connect with colleagues and the next generation of healthcare providers. During the COVID pandemic, the amount of health misinformation online spread like wildfire, and more and more patients turned to the internet to learn about medical issues. That’s when more doctors jumped onboard and began sharing health-related educational content on social media. I started making more videos to combat dangerous eye-related trends (e.g., blow drying eyelashes) and to promote good eye health (e.g., practicing good contact lens hygiene and stopping eye rubbing).

Brian Boxer Wachler: During the pandemic my twin 14-year old daughters roped me into TikTok with, “Dad, there are some really good doctors on TikTok – we think you’d be great and we can help you get started.” I found it to be a platform that enabled widespread dissemination of health information and I wanted to provide a public service on the app.

Rupa Wong: Back in 2018, I began to notice a rise of “celebrities” touting medical advice – goat milk for babies and the like. The only health care providers I was seeing on social media at that time were medical students and residents, and of course, their knowledge is limited at that stage of their educational journey. I realized that I couldn’t bemoan misinformation online if those of us more in our mid- to late careers were not contributing to the conversation. Initially, I saw social media as a way to educate and inform about pediatric ophthalmology and adult strabismus. This focus has shifted as my platform has grown. I discovered that people were interested in my personal journey balancing work and life, becoming a practice owner and navigating the hurdles that come with those.

Vicki Chan: As a physician, teaching is part of the job – whether it be patients or trainees – so making educational videos always came naturally. I could simply pull a question from my comment section or explain something I saw at work. Education is something I feel I can give back to my followers, mixed in with the more lighthearted content I do for fun.

Do you feel there is a conflict of interest using TikTok to spread awareness about eye disease and health, given that increased phone use is said to contribute to high rates of myopia?
 

DZ: The jury is still out on whether phone usage and screen time significantly increases myopia development and progression. However, the evidence linking myopia progression and decreased outdoor time and sun exposure is very strong. We should all be limiting our daily screen time exposure, especially children, who should be encouraged to play outdoors during those critical years of eye development. We must nurture our mental health and real-life interpersonal relationships.

Digital device usage has also been linked to dry eye disease – we drastically decrease our blink rate when staring at a screen – and nighttime usage can disrupt our sleep quality because blue light suppresses melatonin release. As with most things in life, social media usage should be done in moderation. It’s up to the user how to draw the most value out of their social media consumption, and I can only hope that they will choose entertaining eye health content more times than not!

BBW: It’s true that excessive near vision focusing in teens and children can increase myopia. We saw that before smart phones –  with teens and kids reading books and studying – which is why I don’t see a conflict of interest using TikTok to spread health information. I recently discussed this topic on AllAboutVision.com and recommended people visit their Myopia Hub to learn about how they can reduce myopia progression.

RW: In actuality, no study has documented that phone use in and of itself contributes to high rates of myopia. Studies have shown that near work contributes to myopia. However, my audience tends to be outside of the myogenic age range – I’m trying to reach parents, not the kids themselves. As far as I know, 40-year-olds are not succumbing to worsening myopia! In fact, I educate extensively on myopia management – on social media as well as at the AAO, Hawaiian Eye, and AAPOS. Personally, I have very strict screen time limits for my own kids.

VC: Not really – if people aren't watching my videos, they are watching something else. Moreover, the progression of myopia in children isn't so much linked with near work (this includes actual reading and school work, not just phone usage), rather the lack of outdoor play time. So as long as people are getting enough outdoor play time to balance out their phone usage, we are good.

Do different social media apps allow you to reach new demographics of patients and, as a result, reach them earlier in their potential disease progression?
 

DZ: Every social media platform caters to a unique demographic. Tiktok and Instagram tend to serve younger users, while LinkedIn and Facebook users tend to be a bit older. As a result, I am better able to spread awareness about keratoconus on the former platforms and cataract progression and age-related macular degeneration on the latter. Younger patients, especially, are much better informed about the dangers of eye rubbing and the development of corneal ectasia thanks to viral videos on social media!

BBW: A large component of my being a doctor is to inform. It started when I trained residents and fellows how to perform LASIK and Intacs, published papers, and spoke at conferences. Social media enabled me to inform a larger group within and outside the US about Keratoconus and other health topics, and TikTok in particular has expanded my reach to teens and children.

RW: I absolutely know that my social media presence has brought patients to my practice. Social media offers an inexpensive yet extremely effective way to increase SEO discoverability, recruitment, and retention of patients, all of which drive practice profitability. In addition, it provides a deeper connection with patients. There is already a level of trust, since patients feel that they “know” me from social media. As patients are being educated about ocular health topics, they become more empowered to seek care earlier. People will share informative posts and videos with family members and friends, amplifying its reach and encouraging discussion.

VC: I do not get new patients through social media (I am a specialist in a multispecialty group, so all my referrals are internal), but I have noticed that my content is reaching many more people. I hope that this education encourages people to see their doctors and have important conversations that they otherwise may not have had.

Would you recommend using social media to other ophthalmologists?
 

DZ: Absolutely! It’s incredible how hungry patients and the general public are for health education! They want to know the risks and benefits of common eye procedures (e.g., LASIK), and they are eager to know what eye surgery looks like (e.g., cataract surgery). One of my most popular posts is a TikTok video on the meaning of astigmatism, which amassed over one million views in only three days. You’d be amazed to know how many topics we as ophthalmologists may find “boring,” but are found to be absolutely fascinating by someone outside the field!

BBW: Social media has a great potential to spread awareness, but whether an ophthalmologist should embrace it for that purpose is a personal decision. Here’s one tip: providing pure information without making it engaging and/or entertaining will not see much success with the algorithms, so baking creativity into the content is key.

RW: Social media is not for everyone. It requires a lot of time and effort and messaging must be clear from the onset, otherwise it can hurt a physician or their practice. It also has to feel authentic – my husband, also an ophthalmologist whom I work alongside, has no desire to engage in social media professionally. I have personally found it to be extremely rewarding to know that I have helped an adult halfway across the world to find a strabismus specialist to correct their exotropia. My reach extends more than just my Hawaii community and I think that is extremely powerful.

VC: Definitely. Social media is really like the modern day yellow pages. Whether you like it or not, people are searching, posting, and having conversations about you online. So, unless you are creating your own platform, you won't have any control over this. I also encourage doctors to utilize their platforms to educate the public – there is a huge void right now that is getting filled with misinformation. Doctors' voices online are needed. Lastly, building your platform and brand is also great marketing and a good way to get your name out there.

Have any problems arisen from your increased following?
 

DZ: Anytime you “put yourself out there,” you are making yourself vulnerable to criticism and judgment from others. Even the most benign statement can be taken out of context, misconstrued, and possibly offend someone. I find solace in knowing that people are listening and actually care about what I have to say. I am very much an introvert, and the thing I hate the most is disappointing others. But thanks to social media, I have grown much tougher skin. I feel more confident about standing up for what I believe in. But in general, my experience on social media has been overwhelmingly positive, and I am so grateful for the kindness and support shown by others as we navigate social media in healthcare together.

BBW: I remember when I started discussing topics outside of ophthalmology some trolls would comment, “Why is an eye doctor talking about ______?”  At first it bothered me. I forged ahead, since I knew that I was advocating for correct health information (there is a fair amount of misinformation on social media) and I had the research to back up my videos.  Eventually that troll chatter dissipated.

RW: I am extremely careful of the type of content I post. I do not post my whereabouts in real time, nor specific information about my children (i.e., where they attend school, after-school activities, etc). My husband would say that being recognized is a problem, which randomly happened when we were on vacation in Whistler last month, but that’s pretty rare!

VC: Obviously, trolls are a problem. They are a big reason many doctors don't build a platform or share anything personal online. People can be really mean hiding behind an anonymous account. I have learned to ignore, delete, and block any comment or account that is overly aggressive, rude, or spreads misinformation – just like I would set a boundary in person.

What is the danger of medical misinformation on social media platforms, and do you spend a lot of time debunking it?
 

DZ: If ophthalmologists are not present online, patients are left with mounds of non factual and sometimes dangerous advice (e.g., sungazing) from self-proclaimed “experts.” Ophthalmologists have a responsibility to educate and meet patients where they’re at (i.e., online), and with social media, they can reach patients far beyond their own exam rooms.

BBW: I was able to quickly relate to Gen-Z by speaking their language using “cap” (meaning something is a lie or not true and “not cap” means it’s true). I created my own blue hat with CAP on it. I became known as the “cap doctor” on TikTok for calling out videos with false health information or endorsing videos with correct information. The app algorithms don’t verify fact or false content when it decides if a video will go viral, so it’s a bit of the wild west out there. This is why I decided to write my book, INFLUENCED: The Impact of Social Media on Our Perception (published last year) – to empower people with tools to successfully use social media and also to protect them and their children on the apps. Social media is like fire – it can be used for illumination or you can badly burn yourself.

RW: This is exactly why I co-founded the Association for Health Care on Social Media (AHSM) back in 2019 with nine other physicians. AHSM is a non-profit organization focused on providing educational resources for social media usage by healthcare professionals; it advocates for social media as an important public health tool in combating misinformation. I try my best to debunk the medical misinformation I come across to the best of my ability. This was quite literally a full-time job at the beginning of the COVID-19 pandemic! The trick with debunking medical misinformation is to do it in a way that invites discourse and is not authoritarian in tone. Doing otherwise only invites trolls to chime in. If our goal really is to change minds, then we have to alter the way we approach these hot button topics.

VC: Medical misinformation, especially on social media, is a huge problem. There is so much that it would be impossible to address it all – moreover, there are new myths popping up every day! I try to pick and choose my battles – focusing on the most timely (e.g., COVID-19 and vaccinations during the pandemic) and/or those relevant to my field of ophthalmology. The dangers of this are, 1) the time you will spend due to the sheer amount of misinformation out there, and 2) angering the trolls (who have no problem arguing in the comments section despite their lack of education. My advice: ignore, delete, block!)