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Study: LASIK Web sites lacking comprehensive information
Surgeons need to ensure that information on their Web sites does not mislead their patients, one author advises.
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LONDON — There is a lack of comprehensive, balanced and well-referenced information on the complications of LASIK surgery available on the Internet, a recent study concluded.
The study, published in the Journal of Medical Internet Research, evaluated 21 Web sites to assess the quantity and quality of online information on LASIK complications that is available to prospective patients.
Daragh K. Fahey, MRCOphth, who co-authored the study, expressed concerns over the lack of a governing body acting as a “gatekeeper of Web page publications.”
“I would think some independent body should set the standards to which ophthalmologists would adhere,” Dr. Fahey told Ocular Surgery News.
Dr. Fahey, who trained as an ophthalmologist but now works in public health policy at St. Pancras Hospital in London, said he believes LASIK is a predominantly safe procedure, but that much is still unknown about complications that could develop in the future.
“LASIK was first performed only 12 years ago and United States Food and Drug Administration approval was only granted 7 years ago; therefore, there is a concern as to what may happen to these corneas in the future,” he wrote in the study’s introduction.
Dr. Fahey said he decided to conduct the study when a more informal evaluation of LASIK-related Web sites left him uneasy over the quality of information he found.
“I came across Web sites that made me realize that anybody could write anything they want. I could see this becoming a problem down the line as patients with complications would claim that the risks were not made clear on the Web site,” he said.
Dr. Fahey said he conducted a search on Medline (http://medline.cos.com) for previous studies that specifically examined the quality of ophthalmic Web sites and found none.
Evaluating the sites
Dr. Fahey based his evaluations of the Web sites on content quality, authorship and technical aspects of the information on the complications of LASIK, according to the study.
He evaluated 21 Web sites between July 16 and July 22, 2002. He included the first 17 English-language sites that appeared when the word LASIK was searched for with the Google search engine (www.google.com), and the first four United Kingdom sites that appeared using the same keyword, but with the Yahoo search engine (www.yahoo.com) limited to U.K. sites.
Dr. Fahey said his searches returned 150,000 hits and 1,010 hits, respectively, but he chose to limit his evaluation to the first 21 English-language sites because “it was felt that most English-speaking potential LASIK customers would not extend their search beyond this number of sites.”
He noted that he did not consult consumers when devising the search strategy.
The Web sites included 16 from North America, four from the United Kingdom and one from India. He disregarded sites that provided only contact information for LASIK surgeons.
Dr. Fahey assessed each site while being masked to the source. He compiled objective information on criteria including, but not limited to: the site’s creator; its country of origin; if information on complications was available; if the page with information on complications indicated when it was last updated; if the author of the information was identified; and if responsibility for the given information is waived.
The information on complications was then assessed and marked subjectively on an evaluation form based on authorship, content and technical quality, Dr. Fahey said.
Web site content lacking
The results show that 16 of the 21 Web sites mentioned the potential complications of LASIK. While on the whole the U.S. Web sites mentioned complications more than the U.K. sites did, the difference was not statistically significant.
Of the 16 sites that had information on complications, the author was clearly identified in five (31%), the content was referenced in two (12.5%) and evidence of the information having been updated was seen in two (12.5%).
While the study found the caliber of information on complications to be lacking, Dr. Fahey pointed out that not all the findings were negative.
Most of the sites scored well on the quality of headings, subheadings and footers, indicating that Dr. Fahey thought they would aid the visitor’s navigation through the site.
He said the study’s findings support recent work at the Southern California College of Optometry, which looked at 96 Web sites and rated 46% of them “minimally informative,” 26% “markedly informative” and 28% “moderately informative.”
“The poor quality of the information represents a negligent omission, as the public are being misled into believing that LASIK is without risk,” he concluded. “This may lead to liability cases by patients with complications whose decision to have LASIK was based on the information they read on the Web site.”
Dr. Fahey said he believes that if a surgeon is responsible for the content of the site, he or she bears the burden to ensure that the information “is accurate, well-referenced and balanced.”
He also explored the issue of if health Web sites should be barred from using a waiver of responsibility for the information they contain.
“There is an argument that the authors of the Web site could be held liable unless they have a waiver. On the other hand, perhaps health Web sites should be prevented from using a waiver to ensure greater accuracy of the information provided,” he said.
Stamp of approval
To combat the problem of substandard information, Dr. Fahey said that a possible solution is to have an independent body set up specifically to evaluate the content of ophthalmologic Web sites.
“It is an extremely difficult challenge, but I think some respected body should set standards for ophthalmic Web sites. They would recommend that the public only use and read sites that have been approved by them,” he said.
“The ophthalmologists would then ensure that their sites adhere to their standards and apply to get the stamp of approval from the respected body,” he said.
For Your Information:
- Daragh K. Fahey, MB, BCh, BAO, MMedSci, MSc, MRCOphth, can be reached at the Public Health Department, Camden Primary Care Trust, St. Pancras Hospital, 4 St. Pancras Way, London, NW1 OPE, England; (44) 207-530-3565; e-mail: faheydaragh@hotmail.com.
Reference:
- Fahey DK, Weinberg J. LASIK complications and the Internet: Is the public being misled? J Med Internet Res. 2003;5:e2.