Open Access Original
Article
DOI: 10.7759/cureus.22702
Current Public Trends in the Discussion of Dry
Eyes: A Cross-Sectional Analysis of Popular
Content on TikTok
Review began 02/13/2022
Review ended 02/24/2022
Shahrukh Naseer 1 , Sazid Hasan 1 , Julia Bhuiyan 2 , Anuradha Prasad 3
Published 02/28/2022
© Copyright 2022
Naseer et al. This is an open access article
distributed under the terms of the Creative
1. Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester Hills, USA 2. Ophthalmology,
Harvard University, Cambridge, USA 3. Ophthalmology, Beaumont Hospital, Royal Oak, USA
Commons Attribution License CC-BY 4.0.,
which permits unrestricted use, distribution,
and reproduction in any medium, provided
Corresponding author: Sazid Hasan, shasan2@oakland.edu
the original author and source are credited.
Abstract
Introduction
Dry eye disease (DED) is a common ocular pathology with significant impacts on both quality of life and
visual function. One platform where individuals are receiving healthcare information is TikTok, the world's
fastest-growing social media platform. Though used by more than one billion users, current literature is not
established to assess the quality of information on TikTok. The purpose of this study was to assess the
quality of DED-related medical information present on TikTok.
Methods
We conducted a cross-sectional analysis of DED content on TikTok, utilizing the search term #DryEye to
assess the top 150 videos appearing on December 20, 2021. Included videos were analyzed for descriptive
statistics, including views, likes, uploader profession, and the number of uploader followers. Videos were
assessed utilizing DISCERN, a tool used to appraise consumer health information. The one-way analysis of
variance (ANOVA) was used to determine statistical significance groups.
Results
A total of 101 videos were included in the final analysis. When comparing content creators, physicians
received a significantly greater number of views and higher DISCERN scores (p<0.05) than non-physician
medical providers and non-medical individuals. The content of the videos were educational content (n=39,
38.6%) or treatment information (n=37, 36.6%), followed by home remedies (n=10, 9.9%) and personal
anecdotes (n=8, 7.9%). Videos with rich supplementary visuals (multiple images/moving images) had higher
DISCERN scores compared to videos with no supplementary visuals or one supplementary visual (p<0.01).
Conclusion
With the growing popularity of TikTok, it is important to provide high-quality information to ensure the
dissemination of medically accurate information and reduce the prevalence of disinformation. Our results
demonstrate that while TikTok is a powerful platform, the quality of videos can still be vastly improved.
Content creators, regardless of profession, can improve their DISCERN through listing sources, comparing
treatments, and discussing risks/outcomes of various treatment modalities.
Categories: Ophthalmology, Quality Improvement, Public Health
Keywords: discern, cross-sectional analysis, tiktok, social media, dry eyes
Introduction
Dry eye disease (DED) is a commonly encountered chronic pathology in ophthalmic practice characterized
by a reduction in the quality of the tear film [1]. With an estimated prevalence of between 5% and 50% of the
adult population, DED is an ever-growing public health concern with a significant socio-economic impact
[1-2]. It has been shown to tremendously affect the quality of life, as symptoms can interfere with common
activities such as reading, driving, or using electronic screens [3]. At present, depending on the severity and
characteristics of the symptoms, there are many different treatment options for DED at a physician's
disposal, ranging from over-the-counter treatment options, such as artificial tears, repetitive hot
compress, increasing blink repetition, and omega-3 fatty acids to in-office procedures and prescription
medications [3-4].
Despite the many treatment options, many individuals affected with DED may not seek professional help for
their condition. Within the last decade, there has been an increase in the use of social media platforms
amongst physicians and non-physicians alike to disseminate medical knowledge pertaining to specific
diseases [5]. One study that randomly surveyed 160 ophthalmologists primarily from the United States
How to cite this article
Naseer S, Hasan S, Bhuiyan J, et al. (February 28, 2022) Current Public Trends in the Discussion of Dry Eyes: A Cross-Sectional Analysis of
Popular Content on TikTok. Cureus 14(2): e22702. DOI 10.7759/cureus.22702
demonstrated that upwards of 40% of these physicians use social media for professional reasons, including
publicizing their practice, demonstrating expertise in the field, and educating patients and health
professionals [6]. Physicians and non-physicians are increasingly using TikTok, an application where users
can upload short mobile videos, to impart medical advice [7]. Given that this social media platform already
has over one billion active users worldwide, TikTok’s popularity may provide significant opportunities for
health communication [8-9].
While TikTok holds tremendous potential as a feasible tool of patient education, the quality of the shared
information is a concern [10]. One study found that the majority of videos that they had assessed did not
contain high-quality educational content [11-12]. Encountering low-quality medical information on social
media platforms may pose dangerous risks for patients, as they may make crucial medical decisions based on
potentially faulty information that could have adverse effects. Beyond the aforementioned study, however,
current literature on the information quality of these videos is limited and consists primarily of short
reports without extensive analysis. Furthermore, there is a lack of investigation into the communication and
visual quality of these videos [10].
The quality of information on DED available to the public on social media is not well-characterized. In this
cross-sectional study, we seek to contribute to the existing literature by assessing the quality of medical
information provided in videos shared on TikTok related to DED with regards to the type of content creator,
quality of communication, and video content. With this information, we hope that medical
providers, particularly ophthalmologists and optometrists, and the community of content creators at large
may be in a more informed position to develop higher-quality content for their amassing viewership of
individuals affected by DED.
Materials And Methods
A cross-sectional analysis of DED content on TikTok was conducted on December 20, 2021, using the
#DryEye search term. The 150 most popular videos related to DED were chosen based on our inclusion
criteria and included in our analysis. Videos were included if they discussed or presented anything relevant
to DED, had a minimum of 1,000 views, and were in English (Figure 1). Forty-nine videos were excluded, as
they were unrelated to DED, had less than 1,000 views, were not in English, or were duplicates. For each
video, descriptive statistics were recorded, including video view count, likes, comments, uploader type,
uploader gender, and physician specialty if present. Content creators were further categorized into
influencer group types based on followers (nano-influencers having one to 10,000 followers, microinfluencers having 10,000 to 50,000 followers, mid-tier influencers having 50,000 to 500,000 followers,
macro-influencers having 500,000 to one million followers, and mega influencers having one million to five
million followers) [13]. The videos were also categorized on video length: 0-15 seconds, 15-30 seconds, 3045 seconds, and >45 seconds [13-14]. Videos were then also stratified by the quality of communication and
were placed in group 1, group 2, or group 3: group 1 videos had no supplementary visuals, group 2 videos
had minimal supplementary visuals (i.e., one image), and group 3 with videos rich in supplementary visuals
(i.e., moving image, multiple images). The videos were finally assessed utilizing DISCERN, a tool used to
appraise consumer health information on a scale of 1 (poor) through 5 (excellent) for 15 questions.
Pearson’s correlation was calculated to determine inter-rater reliability.
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FIGURE 1: Video Inclusion/Exclusion Flow Diagram
Numerical data were summarized as mean ± standard deviation and categorical variables were summarized
as n (%). Differences between the medical provider types were examined using an unpaired, independent
two-sample t-test for continuous outcomes with normal distributions. One-way analysis of variance
(ANOVA) is used to determine statistical significance between the means of three or more independent
groups. Tukey's Honest significant difference test was used to calculate differences in mean DISCERN scores
between content creators. Statistical significance was set at p < 0.05. Analyses were performed using
Microsoft Excel v. 2103 (Microsoft Corporation, Redmond, Washington).
Results
A total of 101 videos meeting the inclusion criteria were included in our final analysis. The videos had a total
of 98,170,746 views, amassing 6,277,452 likes and 65,738 comments. Quality scores utilizing DISCERN
ranged from 21 to 50, with a mean DISCERN score of 33.91 with high inter-rater reliability (Cohen's Kappa >
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0.9).
When assessing gender distribution, most content creators were female (n=81, 80.2%) while a smaller
number were male (n=17, 16.8%) (Table 1). Content creators were most commonly non-physician medical
providers (n=65, 64.4%), followed by non-medical individuals (n=17, 16.8%), licensed physicians (n=16,
15.8%), and private companies (n=3, 3.0%). Among these groups, physicians received a significantly greater
number of views (p<0.001). Furthermore, DISCERN scores were significantly higher for physicians as
compared to other content creators (p=0.0151). Of videos that identified provider type, optometrists had
more video content by volume (n=61, 60.4%) than ophthalmologists (n=16, 15.8%) (Table 1). Content
creators specializing in ophthalmology received significantly more views (p<0.001), as well as significantly
higher DISCERN scores (p=0.0319). There was no significant difference in the number of likes or comments
between these provider types.
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Mean
Total Number
Mean Number of
of Videos, (%)
Views, (SD)
P-Value
Mean Number
of Likes, (SD)
P-Value
Mean Number of
Comments, (SD)
P-Value
DISCERN
Scores,
P-Value
(SD)
Content Creator
Physician
Non-physician
medical provider
16 (15.84)
65 (64.36)
4,784,567
34,930 (87,372)
(1,114,133)
1,007,088
79,791
(2,777,836)
(347,239)
P<0.001*
Non-medical
Individual
Private company
17 (16.83)
3 (2.97)
1,132,564
(3,655,497)
1,933,711
(2,182,004)
257 (421)
38.25 (6.88)
835 (4,309)
33.85 (6.69)
P=0.864*
P=0.910*
P<0.01*
23,537 (48,262)
311 (693)
30.82 (7.88)
44,010 (56,256)
677 (1,113)
29.67 (2.31)
Provider Type
Ophthalmology
16 (15.84)
4,784,567
34,930 (87,372)
(1,114,133)
P=0.0001^
Optometry
61 (60.4)
257 (421)
P=0.59^
1,055,317
83,760
(2,861,215)
(358,188)
796,293
63,660
(2,509,603)
(312,015)
38.25 (6.88)
P=0.58^
P=0.032^
882 (4,447)
34.05 (6.83)
649 (3,856)
33.91 (7.03)
Gender
Female
81 (80.2)
Male
17 (16.83)
Private company
3 (2.97)
1,639,405
(3,680,726)
P=0.425*
1,933,711
58,173 (92,629)
P=0.991*
656 (1,009)
P=1*
34.65 (8.17)
44,010 (56,256)
677 (1,113)
29.67 (2.31)
102,586 (99,071)
5,001 (5,494)
82 (88)
32.80 (7.44)
1,223,030
115,385
(3,241,257)
(441,418)
1,254 (5,540)
33.31 (4.74)
(2,182,004)
P=0.54*
Video Types
Home Remedy
Educational
Content
Personal
Anecdote
Product
Advertisement
Treatment Info
10 (9.9)
39 (38.61)
8 (7.92)
7 (6.93)
37 (36.63)
722,227
(965,961)
2,272,758
(5,659,796)
806,658
(1,902,198)
P=0.548*
32,212 (43,350)
P=0.689*
2856 (452)
P=0.336*
25.63 (9.15)
34,862 (63,176)
552 (1,011)
33.57 (7.07)
35,070 (95,842)
282 (547)
36.74 (7.63)
P=0.0014*
TABLE 1: Overview of DED Content on TikTok
*One-way analysis of variance (ANOVA); ^Two-tailed T-test; DED: dry eye disease
The videos were most commonly educational content (n=39, 38.6%) or treatment information (n=37, 36.6%),
followed by home remedies (n=10, 9.9%), personal anecdotes (n=8, 7.9%), and product advertisements (n=7,
6.9%) (Table 1). There was no significant difference in the number of views, likes, or comments across these
various types of videos. However, DISCERN scores were significantly higher for videos regarding treatment
information compared to other video types (p=0.0014).
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While there was no significant difference in DISCERN score between most groups, DISCERN scores were
significantly lower for non-medical individuals compared to physicians (p=0.0131). There was no significant
difference in the number of likes or comments among these groups. With regards to the type of influencer,
micro-influencers had the highest mean DISCERN score while macro-influencers had the lowest mean
DISCERN score; however, there was no significant correlation between influencer type and DISCERN score
(p>0.05).
Content creators scored highest on DISCERN questions 1 (“Are the aims clear?”), 2 (“Does it achieve its
aims?”), 3 (“Is it relevant?”), and 6 (“Is it balanced and unbiased?”) (Figure 2). However, scores were
distinctively lower on DISCERN questions 4 (“Is it clear what sources of information were used?”), 5 (“Is it
clear when the information used was produced?”), 7 (“Does it provide details of additional sources?”), 8
(“Does it refer to areas of uncertainty?”), 11 (“Does it describe the risks of each treatment?”), and 12 (“Does
it describe what would happen if no treatment is used?”) (Figure 2). Medical providers appeared to score
higher on most DISCERN questions when compared to non-medical individuals.
FIGURE 2: Comparison of Mean Discern Scores Between Medical
Providers and Non-Medical Content Creators
With regards to video content, there was no significant correlation between the quality of communication
and the average number of views. However, DISCERN scores were significantly higher for videos that were
categorized as Category 3 visual quality (rich supplementary visuals, including multiple images or moving
images) compared to videos categorized as Category 1 visual quality (no supplementary visuals) or Category
2 visual quality (one supplementary visual) (p=0.0104) (Table 2). In addition, DISCERN scores were
significantly higher for videos that were 30 to 45 seconds in duration (p=0.0201) (Table 3). Shorter videos of
up to 15 seconds in duration had the lowest mean DISCERN score.
Quality of Communication
N
Mean
SD
Category 1 (No supplementary visuals)
39
31.87
6.538
Category 2 (Minimal supplementary visuals)
5
28.8
4.494
Category 3 (Rich in supplementary visuals)
57
35.52
7.043
P
P=0.01*
TABLE 2: Comparison of Quality of Communication and Mean DISCERN Scores
*One-way analysis of variance (ANOVA)
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Video Length (seconds)
N
Mean DISCERN
SD
0-15
40
31.075
6.858
15-30
21
34.762
7.368
30-45
23
36.261
7.405
>45
17
35.563
6.460
P
P <0.01*
TABLE 3: Comparison of Video Length and Mean DISCERN Scores
*One-way analysis of variance (ANOVA)
Of the videos with treatment information, the most commonly recommended treatment was lifestyle
changes (n=31, 37.8%), which included preventative measures (e.g., avoidance of eyeliner and false
eyelashes, limited screen time), diet modifications (e.g., omega-3 fatty acid supplements), and daily
practices (e.g., increase in blink rate, use of blue-light glasses, 20-20-20 rule in which an individual looks at
something 20 feet away for 20 seconds every 20 minutes, and use of eye mask cover while sleeping). This
was followed by at-home treatments such as rice socks and warm compresses (n=17, 20.7%). Other
recommended treatments included intense pulsed light (IPL) therapy (n=15, 18.3%) and eye drops (n=11,
13.4%). The least recommended intervention was acupressure (n=8, 9.8%).
Discussion
The use of social media as a source of information has been gaining popularity, especially as individuals are
gravitating toward simple, convenient answers rather than attaining a perceived, complex professional
recommendation [15]. Applications such as TikTok provide an accessible way for patients to seek medical
advice, especially due to its extensive popularity, widespread use among health professionals, and lack of
cost. While TikTok has been widely investigated as a channel of health communication for a variety of
conditions, the quality of information on DED available to the public through this social media platform is
not yet well-characterized. Our results demonstrate that TikTok is a powerful tool for patient education
regarding DED. The 101 videos analyzed in our study amassed nearly 100 million views and over six million
likes, as well as tens of thousands of comments and shares, evident to TikTok’s tremendous potential for
health outreach. Thus, we suggest that it is in the physician's best interest to provide educational social
media content for multiple reasons. By providing basic information such as the use of artificial tears as an
initial treatment, physicians can help reduce unnecessary office visits. Additionally, most physicians have
the ability to provide unbiased content, as opposed to pharmaceutical companies and physicians serving in
consulting roles to them.
We identified four main types of content creators, including licensed physicians, non-physician medical
providers, non-medical individuals, and private companies. Non-physician medical providers contributed
the most videos while private companies contributed the fewest. We found that physicians received a
significantly greater number of views and higher DISCERN scores compared to other content creators. This
finding is consistent with that of previous studies, which suggest that physicians are more trusted as health
and medical information sources among patients as compared to non-physician sources [8,14]. A possible
explanation for this is that physicians are objectively more qualified with greater knowledge and
understanding of DED due to the extensive preparation required to earn a medical license (i.e., graduating
medical school, receiving postgraduate training through residency, passing a rigorous medical licensing
examination) [16]. DISCERN scores were significantly lower for non-medical individuals compared to
physicians, reflecting the potentially greater quality of information associated with a more extensive
comprehension of DED. Our findings that micro-influencers had the highest mean DISCERN score while
macro-influencers had the lowest mean DISCERN score, maybe a reflection of popular creators’ abilities to
disseminate information of lower quality.
With regards to specific DISCERN categories, all content creators scored distinctively lower on DISCERN
questions related to sources of the information they provided, as well as questions concerning treatment risk
and necessity. Our findings support those of the existing literature, as social media resources have been
found to frequently lack source citation and present opinions as fact [17-18]. To improve on this particular
aspect of information quality, content creators can cite relevant sources within the video (e.g., through the
TikTok text feature) and address the risks of the proposed treatment. This is further supported by our finding
that longer videos of 30 to 45 seconds in duration had significantly higher DISCERN scores; taking the time
to address the sources and limitations of the provided information can increase the quality of medical
information in videos. It is also important to recognize that despite the importance of lifestyle
modifications, the most commonly recommended treatment in videos included in our analysis, this is not in
line with step therapy (the practice of beginning treatment of a medical condition with the most preferred
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method) and standard of care for the treatment of dry eyes.
In response to the lack of exploration of the effects of the video quality of communication, our study
investigated the relationship between quality of communication and quality of DED-related health
information [8,10]. We found rich visual quality (Category 3) videos that included multiple and/or moving
images to be associated with significantly higher DISCERN scores when compared to other videos of less rich
visual quality (Category 1 or Category 2). This is supported by the existing literature, which has found the
richness of communication to be important in the reception of knowledge on social media, especially as
visual communication is practiced with regards to specific settings (i.e., professional health advisory) and
audiences, allowing for the contextualization of shared information [19]. Evidently, greater quality of
communication can foster increased quality of shared health information, and we encourage content
creators to utilize rich supplementary visuals, such as multiple or moving images, to support the
information they present.
While our findings provide an introduction to the quality of content uploaded to TikTok, this study has
several limitations. Due to the cross-sectional nature of our study, we are unable to establish any causal
relationships. Furthermore, our study was limited to videos in English; therefore, our findings cannot be
extended to other popular languages in TikTok videos such as Spanish or Chinese. We encourage further
investigations with the aim of our study in other languages for a more substantial understanding of the
quality of DED-related information shared on TikTok. There is also a lack of demographic information on the
videos’ viewers, which would help obtain deeper insight into the extent of health outreach. Lastly, there are
several other methods that could be used to appraise consumer health information, including the DISCERN,
Quality Evaluation Scoring Tool, and JAMA benchmarks. While our study only used DISCERN in particular
due to its successful use in the evaluation of health information shared online, we encourage future studies
of this variety in health information to use more evaluation tools to triangulate the validity of our findings.
Conclusions
Social media has the potential to be a powerful tool for medical education, and we recommend that
physicians and healthcare practitioners provide high-quality information to advance healthcare literacy.
Physicians can improve the quality of information shared in their videos through various methods, including
the use of rich supplementary material, citation of relevant sources, and thorough evaluation of the risks
and necessity of proposed treatments. As the quality of information is higher for videos created by licensed
physicians, we implore viewers to conduct their own research utilizing evidence-based sources and consult
with physicians regarding the treatment for DED.
Additional Information
Disclosures
Human subjects: All authors have confirmed that this study did not involve human participants or tissue.
Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the
following: Payment/services info: All authors have declared that no financial support was received from
any organization for the submitted work. Financial relationships: All authors have declared that they have
no financial relationships at present or within the previous three years with any organizations that might
have an interest in the submitted work. Other relationships: All authors have declared that there are no
other relationships or activities that could appear to have influenced the submitted work.
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