Social Media in Neuro-Ophthalmology: Paradigms, Opportunities, and Strategies

Background: Social media (SoMe) is an integral part of life in the 21st century. Its potential for rapid dissemination and amplification of information offers opportunities for neuro-ophthalmologists to have an outsized voice to share expert-level knowledge with the public, other medical professionals, policymakers, and trainees. However, there are also potential pitfalls, because SoMe may spread incorrect or misleading information. Understanding and using SoMe enables neuro-ophthalmologists to influence and educate that would otherwise be limited by workforce shortages. Evidence acquisition: A PubMed search for the terms "social media" AND "neuro-ophthalmology," "social media" AND "ophthalmology," and "social media" AND "neurology" was performed. Results: Seventy-two neurology articles, 70 ophthalmology articles, and 3 neuro-ophthalmology articles were analyzed. A large proportion of the articles were published in the last 3 years (2020, 2021, 2022). Most articles were analyses of SoMe content; other domains included engagement analysis such as Altmetric analysis, utilization survey, advisory opinion/commentary, literature review, and other. SoMe has been used in medicine to share and recruit for scientific research, medical education, advocacy, mentorship and medical professional networking, and branding, marketing, practice building, and influencing. The American Academy of Neurology, American Academy of Ophthalmology, and North American Neuro-Ophthalmology Society have developed guidelines on the use of SoMe. Conclusions: Neuro-ophthalmologists may benefit greatly from harnessing SoMe for the purposes of academics, advocacy, networking, and marketing. Regularly creating appropriate professional SoMe content can enable the neuro-ophthalmologist to make a global impact.

State-of-the-Art Review Section Editors: Fiona Costello, MD, FRCP(C) Sashank Prasad, MD Social Media in Neuro-Ophthalmology: Paradigms, Opportunities, and Strategies Kevin E. Lai, MD, Aileen A. Antonio, MD, Melissa W. Ko, MD, MBA, Joel P. Epling, MD, Anne X. Nguyen, MD, Andrew R. Carey, MD Background: Social media (SoMe) is an integral part of life in the 21st century. Its potential for rapid dissemination and amplification of information offers opportunities for neuroophthalmologists to have an outsized voice to share expertlevel knowledge with the public, other medical professionals, policymakers, and trainees. However, there are also potential pitfalls, because SoMe may spread incorrect or misleading information. Understanding and using SoMe enables neuro-ophthalmologists to influence and educate that would otherwise be limited by workforce shortages. Evidence Acquisition: A PubMed search for the terms “social media” AND “neuro-ophthalmology,” “social media” AND “ophthalmology,” and “social media” AND “neurology” was performed. Results: Seventy-two neurology articles, 70 ophthalmology articles, and 3 neuro-ophthalmology articles were analyzed. A large proportion of the articles were published in the last 3 years (2020, 2021, 2022). Most articles were analyses of SoMe content; other domains included engagement analysis such as Altmetric analysis, utilization survey, advisory opinion/commentary, literature review, and other. SoMe has been used in medicine to share and recruit for scientific research, medical education, advocacy, mentorship and medical professional networking, and branding, marketing, practice building, and influencing. The American Academy of Neurology, American Academy of Ophthalmology, and North American Neuro-Ophthalmology Society have developed guidelines on the use of SoMe. Conclusions: Neuro-ophthalmologists may benefit greatly from harnessing SoMe for the purposes of academics, advocacy, networking, and marketing. Regularly creating appropriate professional SoMe content can enable the neuro-ophthalmologist to make a global impact. Journal of Neuro-Ophthalmology 2023;43:295–302 doi: 10.1097/WNO.0000000000001896 © 2023 by North American Neuro-Ophthalmology Society Departments of Ophthalmology (KEL, MWK) and Neurology (MWK), Indiana University School of Medicine, Indianapolis, Indiana; Ophthalmology Service (KEL), Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana; NeuroOphthalmology Section (KEL), Midwest Eye Institute, Carmel, Indiana; Circle City Neuro-Ophthalmology (KEL), Carmel, Indiana; Trinity Health Saint Mary’s (AAA), Hauenstein Neurosciences, Grand Rapids, Michigan; Louisiana State University Health Sciences Center (JPE), School of Medicine, New Orleans, Louisiana; Faculty of Medicine and Health Sciences (AXN), McGill University, Montréal, Canada; and Wilmer Eye Institute (ARC), Johns Hopkins University, School of Medicine, Baltimore, Maryland. The authors report no conflicts of interest. Address correspondence to Kevin E. Lai, MD, Neuro-Ophthalmology Section, Midwest Eye Institute, 10300 N. Illinois Street, Suite 1000, Carmel, IN 46290; E-mail: [e-mail] Lai et al: J Neuro-Ophthalmol 2023; 43: 295-302 S ocial media (SoMe), digital communication that facilitates the sharing of information, ideas, and other content (such as videos, audio files, and images) between users, is an integral component of global society in the 21st century. Its influence has profoundly affected life; in 2022, there were 4.59 billion SoMe user accounts worldwide.1 Within medicine, SoMe platforms have been used for multiple purposes, including professional applications such as networking, education, research, and patient-facing communication.2 There are many platforms for SoMe, each offering different experiences (Table 1). SoMe has also been used in harmful ways, such as disseminating misinformation.3 Although this technology is relatively nascent, the obligations of medical professionalism require the extension of nonmaleficence, beneficence, autonomy, and justice principles to SoMe use. Medical societal guidelines may aid in defining and clarifying the bounds of these duties.3–5 As a small subspecialty with significant concerns of provider shortage,6 neuro-ophthalmologists have the opportunity to harness the positive aspects of SoMe to amplify expert-level information, disseminate high-impact research, advocate for neuroophthalmic care, enhance mentorship, networking, and pipeline initiatives for neuro-ophthalmology, and strengthen personal online brand and influence. However, data are scant on the use of SoMe by neuro-ophthalmologists. In 2017, a small survey of neuro-ophthalmologists in the early years of practice indicated that email was preferred above SoMe for contact.7 Despite this preference, other studies indicate that physicians use SoMe in high proportions for personal and professional purposes.8–12 The Journal of Neuro-Ophthalmology (JNO) SoMe team has highlighted key research articles as part of its aim “to expand the journal’s scope, relevance, and value to today’s reader.”13 This review highlights the relevant literature on SoMe use in neurology and ophthalmology and discusses how to implement SoMe in neuro-ophthalmic practice. METHODS A PubMed search for the terms “social media” AND “neuroophthalmology,” “social media” AND “ophthalmology,” AND “social media” AND “neurology” was performed. Articles unrelated to SoMe or that did not investigate SoMe (i.e., used SoMe for patient recruitment) were excluded. 295 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. State-of-the-Art Review TABLE 1. Commonly used social media platforms and potential applications in neuro-ophthalmology Platform Potential Neuro-Ophthalmology Applications Text-Only Twitter Short-form tutorials (“tweetorials”) Sharing publications and other media General patient education Medical education Advocacy Professional networking Marketing Support groups Sharing publications and other media Medical education groups Professional networking Marketing Sharing publications and other media Images and short-video tutorials General patient education Medical education Professional networking Marketing Lectures Animations, clinical findings, and short topic reviews General patient education Medical education Short-form tutorials Sharing publications Professional networking Marketing Short-form tutorials (“tootorials”) Sharing publications General patient education Medical education Professional networking Marketing Long-form tutorials Sharing publications General patient education Medical education Marketing Sharing publications General patient education Medical education Marketing Lectures Explaining publications General patient education Medical education Marketing Facebook Instagram YouTube LinkedIn Mastodon Blogs Forums Podcasts Audio Images Videos Live X X X X X X X X X X X X X X X X X X* X X X X X X X X X X X X X *Only available to certain accounts. Articles unrelated to neurology, ophthalmology, or neuroophthalmology were excluded. Non-English articles were excluded. Where available, investigated SoMe platforms were noted, but not separately searched. The articles were categorized as “content evaluation,” “engagement analysis,” “utilization survey,” “advisory opinion/commentary,” “literature review,” or “other.” Where 296 possible, the investigated audience was noted (general public/patients, trainees, and practicing physicians). RESULTS As of September 15, 2022, there were 549 articles when searching “social media” AND “neurology” and 243 articles Lai et al: J Neuro-Ophthalmol 2023; 43: 295-302 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. State-of-the-Art Review when searching “social media” AND “ophthalmology.” Two articles were found when searching “social media” AND “neuro-ophthalmology”; manual review of each article’s full-text revealed 2 articles in “social media” AND “ophthalmology” that were reclassified as neuro-ophthalmology articles, resulting in 549 neurology, 241 ophthalmology, and 4 neuroophthalmology articles. 72/549 (13.1%) neurology articles, 70/241 (29.0%) ophthalmology articles, and 3/4 (75%) neuro-ophthalmology articles were included for analysis. 45/ 72 (62.5%) of the neurology articles and 53/70 (75.7%) of the ophthalmology articles were published within the last 3 years (2020, 2021, 2022) (Fig. 1). Most articles focused on evaluating SoMe content (Table 2). Other publications included case reports of using SoMe for diagnosis or patient support, investigation of the “TikTok tic” phenomenon as first reported by Pringsheim and Martino,14 editorials by academic journals announcing the implementation of SoMe accounts, and commentary on other articles. Thirty-nine of 47 (83.0%) of the articles evaluating SoMe content investigated the quality of YouTube videos, with TikTok (3/47, 6.4%), Reddit (2/47, 4.3%), Instagram (1/47, 2.1%), and Pinterest (1/47, 2.1%) also evaluated. Eighty-two of 145 (56.6%) articles addressed SoMe use for patients, 11/145 (7.6%) for trainees, and 57/145 (39.3%) for physicians; 9/145 (6.2%) articles had multiple audiences. Of the 3 articles categorized as neuro-ophthalmologyrelated, one was an announcement by the JNO,13 one investigated modes of support for patients with nystagmus and their caregivers,15 and one evaluated the quality of eye movement internet videos.16 PARADIGMS FOR SOCIAL MEDIA ENGAGEMENT How Social Media Is Used A 2021 survey conducted by the European Heart Rhythm Association (EHRA) found 2 general types of users among survey respondents: passive users who “[browse] SoMe rarely engaging in an active manner or providing original content on a regular basis.averaging less than one hour per day of SoMe activity,” and the “super-user” who “engages in regular discussion and provides content on a steady basis, spending a lot of time (even more than 30 [hours] per week) on SoMe.”17 Framing this concept in neuro-ophthalmic terms, SoMe engagement can be categorized as “afferent” (content consumption) and “efferent” (content creation). Seventy-four of the total 145 (51.0%) reviewed articles evaluated efferent strategies. No direct surveys of SoMe use among neuroophthalmologists were available to review. Afferent (Content Consumption) Physicians Physicians predominantly reported using SoMe for maintaining personal connections and social interaction.9,12,18 In Saudi Arabia, the most common reason for SoMe use was for personal purposes among surveyed ophthalmologists (94.3%); 64.4% used SoMe exclusively for personal purposes.11 Women and trainees/early career physicians are more likely to experience challenges in personal and professional domains and find SoMe beneficial for overcoming those challenges.18 Patients Earlier surveys of SoMe use in patients suggested a substantial disparity in comfort level using SoMe between young (18–45 years) and older (.45 years) patients.19 In surveys of various cohorts and analyses of SoMe posts, patients and caregivers used SoMe for social support,20–23 medical information,24,25 referral recommendations,25,26 and treatment advice.24 Efferent (Content Creation) The EHRA survey found that 42.7% of physician respondents did not create or share content of any kind, 38.3% provided content on a nondaily basis, and 19.0% provided daily content.17 Similarly, a survey of SoMe usage by alumni FIG. 1. Number of social media articles in neurology and ophthalmology. The number of articles containing the keywords “social media” and “neurology” or “ophthalmology” with a PubMed listing from 2012 to September 15, 2022. Lai et al: J Neuro-Ophthalmol 2023; 43: 295-302 297 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. State-of-the-Art Review TABLE 2. Types of social media publications Type of Publication Total (N = 145) Neurology (N = 72) Ophthalmology (N = 70) Neuro-Ophthalmology (N = 3) Content evaluation Engagement analysis Utilization survey Advisory opinion Literature review Other 47 (32.4%) 23 (15.9%) 17 (11.7%) 22 (15.2%) 5 (3.4%) 31 (21.4%) 19 (26.4%) 12 (16.7%) 7 (9.7%) 13 (18.1%) 1 (1.4%) 20 (27.8%) 27 (38.6%) 11 (15.7%) 9 (12.9%) 9 (12.9%) 4 (5.7%) 10 (14.3%) 1 (33.3%) 0 (0.0%) 1 (33.3%) 0 (0.0%) 0 (0.0%) 1 (33.3%) of the University of Miami ophthalmology program (including 5 neuro-ophthalmologists) reported that 19.1% of respondents provided daily content on their professional SoMe accounts.9 Various editorials have described using SoMe for public education, patient recruitment, and disseminating research,27 generating awareness for rare diseases,28 and advocating for patients and policies.2,27,29–33 The North American Neuro-Ophthalmology Society (NANOS) (Twitter: @nanostweets, Instagram: @nanosneuroop), JNO (Twitter and Instagram: @journalneurooph), and the Neuro-Ophthalmology Virtual Education Library (NOVEL) (Twitter and Instagram: @novelnanos) have SoMe accounts that disseminate educational & research information designed for patients, trainees, and physicians. Hashtags Hashtags (denoted by the hash symbol, #) are used before keywords or phrases that allow SoMe platforms to aggregate similar content. They are often used within the body of a post or at the beginning or end of a post to increase visibility to interested users. For example, #neuroophthalmology may be used to highlight posts relevant to neuro-ophthalmology. Phrases are concatenated without spaces; these hashtags can be written in all lowercase (e.g., #opticneuritis) or camel case (e.g., #OpticNeuritis). Social Media Relationships Tingley et al,32 in an oculoplastics literature review, defined relationships found in SoMe as: physician to physician, physician to patients, patient to patient, vendor to physician, education for trainees, research, and government advocacy. Nguyen et al33 explored similar topics within comprehensive ophthalmology. The American Academy of Neurology’s (AAN) position statement on SoMe encourages a similar model.2 OPPORTUNITIES FOR NEUROOPHTHALMOLOGISTS TO USE SOCIAL MEDIA Although research in neuro-ophthalmic SoMe use is scant, principles derived from other studies and editorials suggest 298 ample opportunities for neuro-ophthalmologists to leverage their expertise in impactful ways. SoMe offers neuroophthalmologists a platform for expanding trainee recruitment, educating the general public and physicians, and advocating for neuro-ophthalmic interests. Creating concise, well-informed, clearly explained content is a challenging task, but is a skill neuroophthalmologists often already possess. Because there are disproportionately fewer neuro-ophthalmologists compared with many other specialties,34 a greater proportion of neuroophthalmologists may be needed to generate SoMeappropriate resources. Adapting existing resources may also increase neuro-ophthalmology presence on SoMe. Scientific Research (#Research) Subject Recruitment Multiple studies have been evaluated using SoMe to recruit subjects for research studies. A systematic review in 2016 found mixed efficacy, with 50% finding SoMe most or equally effective to other strategies35 and 50% finding SoMe most or equally cost-effective.35 SoMe may also be optimal for recruiting “hard to reach” subjects such as patients with rare diseases.35,36 These patients are not commonly encountered in clinics, but, owing to the rare nature of their disease, may be members of support groups with SoMe presence. In neuroophthalmology, a quality-of-life study among patients with Leber hereditary optic neuropathy recruited from known support group networks.37 Facebook recruitment was used to survey patients with posterior cortical atrophy to determine the most common and bothersome symptoms.38 There are limitations to research recruitment through SoMe. Surveys are prone to “bots” or automated software impersonating people on SoMe; one study reported 95% of survey respondents within the first 7 hours were suspected bots.39 SoMe use skews toward younger ages, limiting the efficacy of recruiting older adults using SoMe, which may bias participant demographics or limit use in conditions associated with aging.36 Research Collaboration and Generation In the past, colleagues could discuss research ideas at medical conferences and journal clubs. However, these opportunities for planned or spontaneous dialogues have Lai et al: J Neuro-Ophthalmol 2023; 43: 295-302 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. State-of-the-Art Review declined since the onset of the coronavirus-2019 (COVID19) pandemic. SoMe may facilitate discussions and lead to collaborations.40 Many authors are accessible on SoMe, and public conversations can educate and spark research. A prime example of these SoMe-facilitated discussions occurred at the start of the COVID-19 pandemic when a Chinese ophthalmologist warned colleagues of a SARS-like respiratory virus outbreak.40 Dissemination of Published Research Results Informing fellow researchers, physicians, and patients about research results, applications, and patient benefits is a crucial tenet of medical research. Traditionally, this has been accomplished via medical conferences, research meetings, and medical journals in a “closed” fashion (restricted to members/attendees/ fee-based subscribers). There is growing impetus for open access among medical journals to democratize research results, particularly those funded with public money. SoMe can rapidly share research results to billions of users. In addition, SoMe enables sharing media not easily printed such as high-resolution color images and videos. A systematic review in 2021 found clinical practice guidelines had widespread views and engagements among healthcare professionals and patients.41 More journals are using SoMe, and in ophthalmology, among other specialties, this has been associated with greater academic metrics including h-index and impact factor.42 Many academic institutions are recognizing the influence of SoMe in expanding scholarly influence. As the value of SoMe impact increases, individuals in academia may benefit from including SoMe data that capture this scholarship.43 Medical Education (#Meded, #Scicomm) Patient Education Neuro-ophthalmologists educate their patients, referring physicians, and the general public about neuro-ophthalmic disease. SoMe can rapidly promulgate information and reduces the barrier to entry for creators of educational resources. However, content quality is typically not regulated or peer-reviewed; well-produced media can still contain incorrect information. A systematic review of healthcare information on YouTube in 2015 revealed that misinformation or promotion of unapproved/unscientific therapies/topics may adversely affect patient beliefs on controversial subjects.44 Mahjoub et al24 evaluated ophthalmology-related posts on Reddit, finding that many patients asking medical questions received advice from nonphysicians or optometrists. Huang et al,25 in an analysis of ophthalmology-related posts on Instagram, found that most posts were authored by nonophthalmologists, with educational content being the least engaging. Johnson et al45 analyzed pediatric ophthalmology posts on Instagram, discovering a high percentage of vision therapy-related content, with a majority being self-promotion or marketing of some nature. The relative absence of expert-created resources underscores the imperative Lai et al: J Neuro-Ophthalmol 2023; 43: 295-302 for all neuro-ophthalmologists to consider contributing accurate, noncontroversial, accessible expertise on SoMe. Reviews of medical videos on SoMe platforms, especially YouTube, have found that the reliability and quality of content are very heterogeneous.16,46 Given the bevy of information available on the internet, content curation is another skill physicians must possess to deliver excellent patient care. Directing patients to peer-reviewed sources (NANOS, NOVEL, JNO), content created by established neuroophthalmologists, or personally-vetted media ensures that patients have access to accurate and reliable information. Trainee Education Neuro-ophthalmology curriculum is a requirement of ophthalmology resident training.47 Several systematic reviews in graduate medical education found that SoMe was utilized in case-based teaching, online journal clubs, sharing “pearls” of wisdom, educational podcasts and wikis, and screening applicants.48 Blogs, Twitter, podcasts, wikis, and Facebook were all commonly used platforms.48,49 Although the reviews noted that SoMe impact on clinical and test performance outcomes had not been studied, the authors suggested that SoMe could foster a collaborative learning environment and greater trainee engagement.49 Because many neuro-ophthalmologists already participate in medical education, translating existing efforts to SoMe may not require significant equipment purchases or additional time commitments (Table 3). Smartphone-recorded in-clinic mini-lectures can be quickly uploaded to YouTube, TikTok, or a similar platform. De-identified clinical test results (with patient consent) may be annotated and shared on Instagram, Facebook, Twitter, or similar platforms. Topic outlines can be shared as “tweetorials” or blog posts. Advocacy (#Advocacy) Advocacy is the work that influences policy and regulations affecting patients and neuro-ophthalmologists and is vital to neuro-ophthalmic practice. A quick and effective way to advocate for neuro-ophthalmology is by highlighting pertinent issues on SoMe while engaging elected leaders and their staff, the public, their peers, and other healthcare stakeholders. Prospecialty messages can be amplified readily (via shares, retweets, etc), and engaging posts (via likes, etc.) alert leaders at the federal and state level. The AAN50 and American Academy of Ophthalmology (AAO)51 share prewritten letters on SoMe that can be emailed to lawmakers, making it easier for neuro-ophthalmologists to advocate for issues critical to the profession. SoMe engagement during major advocacy events can promote public awareness and continue relationships with legislators beyond the in-person meetings. For example, during AAN’s Neurology on the Hill, following and tagging AAN and legislators’ accounts, using hashtags (i.e., #NOH22, #AANadvocacy) within SoMe posts, and sharing images and videos from the meeting can advance key issues. 299 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. State-of-the-Art Review TABLE 3. Strategies for optimizing social media content production Production Step Strategies Topic selection Keep topics short and focused Ask learners to generate topic ideas Follow the NANOS Neuro-Ophthalmology Illustrated Curriculum Follow the AAO Basic And Clinical Science Course textbook Batch production (record multiple “episodes” in a single sitting) Keep editing and production at bare minimum when starting, insert graphics and other useful visuals where appropriate Release on a regular schedule (e.g., weekly, every other week); scheduling posts ahead of time is possible with most platforms Include learners in production Share prerecorded lectures Batch production Structure content in outline form, create tables, or use simple graphics that improve retention Use shorter paragraphs Recording (for video or audio) Written content (blogs, tweetorials, etc.) AAO, American Academy of Ophthalmology; NANOS, North American Neuro-Ophthalmology Society. SoMe can also advocate for diversity, gender parity, and enhanced educational opportunities within subspecialties.52 The Women Neurologists Group (WNG), a closed Facebook group, connects women neurologists juggling the demands of career and motherhood. WNG also raises awareness and works toward the elimination of gender disparities. Mentorship and Medical Professional Networking (#Mentorship, #Networking) SoMe has also been used for mentorship and professional networking.12,18 With its ability to connect individuals globally, SoMe allows neuro-ophthalmologists to connect with colleagues and identify trainees interested in mentorship. This may be advantageous for medical students at institutions with minimal interaction with neuroophthalmology. Because many SoMe platforms do not verify identity, it is incumbent for the neuro-ophthalmologist to represent credentials and affiliations accurately, and for potential mentees to likewise provide factual information. Despite these challenges, SoMe introduced some of the authors (K.E.L. and J.E., K.E.L. and A.N.), which has led to collaboration on several academic projects. Branding, Marketing, Practice Building, and Influencing (#Branding, #Marketing, #Influencer) SoMe platforms earn money via advertising and many compensate popular content creators. Popular content creators are often called #influencers. Cultivating a professional online presence can positively affect practice development. A survey of ophthalmologists across all subspecialties found that professional SoMe use is more com300 mon among private practice ophthalmologists,9 and onethird of those using SoMe perceived a positive impact compared with only 10% perceiving a negative impact.9 Marketing and branding strategies often involve patient education materials (typically videos) and videos of doctors’ personal statements. STRATEGIES FOR NEUROOPHTHALMOLOGISTS TO ENGAGE IN SOCIAL MEDIA Neuro-ophthalmologists interested in using SoMe may wish to consult guidelines offered by the American Medical Association,53,54 NANOS,5 the AAN,2 the AAO,4 and by Ventola.55 There are also guidelines available on the etiquette of professional scientific disagreement on SoMe.56 General Guidelines for Using Social Media in Neuro-Ophthalmology Choosing a Platform Given the diversity of platforms, individuals interested in using SoMe for neuro-ophthalmology may benefit from selecting one primary platform to host content (Table 4). The Terms of Service for each platform should be considered, to ensure that the aims and purposes of the platform align with the content being shared. Content Professional and personal SoMe accounts should be kept separate; avoid sharing personal information on professional accounts. Professional accounts should contain full name and qualifications (e.g., degree). Employers may have specific SoMe policies for professional accounts. Lai et al: J Neuro-Ophthalmol 2023; 43: 295-302 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. State-of-the-Art Review TABLE 4. Ideas for social media use in neuro-ophthalmology Step 1: what type of content is being shared/created? Step 2: what is the intended audience? Step 3: what platform best suits the type of content being shared/created? Posts containing images and videos have a wider reach, but identifiable patient information should be removed; this includes removing embedded metadata, which may be present in some electronic health record information. There are many audiences on SoMe; whereas content may target a specific audience, posts are accessible to unintended eyes. Any content on the internet may be archived indefinitely, even if deleted. Thus, care should be taken when crafting each post. Adding common hashtags (#eyetwitter, #ophthotwitter, #neurotwitter, etc) can increase visibility and traffic to posts. Links to outside content can be shared with a QR code or a shortened URL via tools such as bitly.com & tinyurl.com. A post template with key brand identifiers (e.g., logo, color palettes) increases identifiability. Releasing content on a regular schedule increases the algorithmic probability of visibility. Likewise, accounts with frequent high-quality updates may generate higher engagement. Behavior It is advisable to maintain a professional and positive tone, avoid making negative statements, and avoid responding to negative comments/reviews. SoMe is not the appropriate forum for delivering telehealth care. Avoid responding to patient-specific issues/questions. Humor is poorly conveyed and received over print; care should be taken when attempting to infuse humor into a post. For example, avoid mocking or derogatory humor. Following and sharing popular and official accounts (e.g., NANOS, JNO, NOVEL) and citing original sources amplify reputable voices. CONCLUSIONS SoMe is a globally used technology with many platforms that offer different experiences. Medical professionals may use SoMe for personal and business use. SoMe can amplify the influence of neuro-ophthalmology in research, education, advocacy, mentorship, and marketing. Organizations such as NANOS, AAN, AAO, and AMA offer resources and guidelines for online professional conduct. Lai et al: J Neuro-Ophthalmol 2023; 43: 295-302 Short-text tutorials Long-form educational articles Images and infographics Videos Audio lectures General public Medical trainees Medical professionals Specialty-specific Choose one primary platform Post regularly and frequently Share and follow reputable sources REFERENCES 1. Dixon S. Number of Global Social Network Users 2018-2022, With Forecasts Up Until 2027 [online], 2022. 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