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Cohort studyBMJ health & care informatics · 2026

How well do we write for patients? Longitudinal analysis of the readability and complexity of 4.6 million ophthalmic clinical letters.

Ariel Yuhan Ong, Christine A Kiire, Siegfried K Wagner … Pearse A Keane

OphthalmologyCohort study

Vast majority of ophthalmology clinic letters are less readable than recommended for patients.

How well do we write for patients? Longitudinal analysis of the readability and complexity of 4.6 million ophthalmic clinical letters.

Ariel Yuhan Ong et al. · BMJ health & care informatics · 2026

Background

Effective clinician-patient communication is a fundamental pillar of high-quality clinical care and can influence patient engagement, treatment adherence and clinical outcomes.

Purpose

We aimed to benchmark this at scale in an ophthalmology setting-the highest-volume outpatient specialty in the United Kingdom (UK) healthcare service.

Methods

Over 4.6 million outpatient clinic letters written for 804 986 patients across 17 subspecialty services were included.

n = 986 patients

Results

most clinic letters were too difficult for patients to read

OR 1.12 (95% CI 1.12 to 1.25)

CI excludes the null - significant

More results

The median FRE was 51.1 (IQR 41.9-58.5), indicating college-level readability which was substantially poorer than recommended for patient-facing materials.

There was a significant decline in FRE over the study period (-0.64 points/annum, p<0.001).

More results

Rate of change varied across subspecialty services and was more pronounced in some such as neuro-ophthalmology (-1.24 points/annum, p<0.001), with few being stable (optometry, p>0.05).

The use of second person terms was very low (median 0 per 100 words, IQR 0.0-1.1).

“

Conclusion

Our findings highlight a persistent gap between policy recommendations and real-world practice, underscoring the need for targeted interventions and innovative approaches to support clearer patient-centred communication to optimise patient outcomes.

Post

How well do we write for patients? Longitudinal analysis of the readability and complexity of 4.6 million ophthalmic clinical letters.

Vast majority of ophthalmology clinic letters are less readable than recommended for patients.

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