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When ophthalmology goes virtual amid a pandemic: content analysis of the 2020 #ASCRSVirtualMeeting

Fathy, Cherie MD, MPH; Cehelyk, Eli BA; Israilevich, Rachel BS; Deiner, Michael PhD; Venkateswaran, Nandini MD; Kim, Terry MD

Author Information
Journal of Cataract & Refractive Surgery: May 2021 - Volume 47 - Issue 5 - p 563-569
doi: 10.1097/j.jcrs.0000000000000463
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The COVID-19 pandemic has fundamentally changed how the ophthalmology community meets. On March 17, 2020, the ASCRS announced the cancellation of its annual meeting. Originally scheduled for May 15 to 20 in Boston, Massachusetts, an in-person meeting was deemed to be too high risk based on the number of COVID cases in Boston and recommendations from the Centers for Disease Control, the World Health Organization, the Massachusetts Department of Health, and the city of Boston.

On April 8, 2020, the ASCRS transitioned its largest in-person meeting of the year to a solely virtual platform for the first time in its history. The meeting, scheduled for May 16 to 17, 2020, offered 2 full days of live and on-demand clinical symposia, courses, scientific sessions, industry-sponsored sessions, and lectures on best practice patterns and reopening strategies in the midst of the COVID-19 pandemic.

Perhaps, equally crucial to the sharing of new information during a conference is the ability to network and share ideas and conference content with colleagues, industry members, and faculty. In light of the new transition to virtual meeting platforms, social media provides a potential networking complement to digitalized conferences. The use of social media in medicine is not a new phenomenon and has been well-documented in the literature.1–3 Social media platforms, such as Twitter, Facebook, and YouTube, have flipped the paradigm of traditional academia by allowing physician-scientists to disseminate educational content with many people outside of their immediate academic community.2 Especially during conferences, Twitter has allowed for discussion of content in real time (tweeting the meeting).4 Furthermore, the ease of communicating with others from across the globe has spurred intercontinental networking and unique research collaborations.1,2

Twitter is a popular microblogging and social networking service that allows users to connect and communicate with each other. The service also allows users to share targeted information through the use of hashtags and mentions (otherwise known as tagging someone in a tweet).1,5 @ASCRStweets, the Twitter handle for the ASCRS organization, has more than 10 000 followers, which enables the ASCRS to directly share information about new research, upcoming meetings, and related programming. For public profile accounts such as the ASCRS, users do not have to follow the account to view tweets, which allows the ASCRS to reach a much wider audience base than traditionally available through platforms such as email listservs and in-person conferences.6 For the virtual meeting, the ASCRS created the hashtag, #ASCRSVirtualMeeting, which tweeters could use to engage in real-time discussions and share their opinions on the 2020 ASCRS virtual meeting content. Furthermore, by clicking on or following that hashtag, users could easily follow all tweets related to the meeting and easily disseminate the information from those tweets.6 This included tweets summarizing or sharing links to studies presented at the ASCRS, content from industry, and social conversations between conference attendees. This opportunity for remote interaction through social media platforms might allow for the ophthalmology community to share ideas more widely, connect with each other across the globe more easily, and might complement in-person meeting activities in the future.

This study aimed to assess the usage and impact of the social media platform Twitter during the 2020 ASCRS virtual Meeting. The specific aims of this article were to (1) identify how social media was used to engage with the conference and conference participants, (2) identify the most commonly discussed topics, and (3) provide insight into how social media can complement ophthalmology's biggest meetings.

METHODS

A retrospective analysis of Twitter use during the 2020 ASCRS Virtual Meeting, which was held online from May 16 to 17, 2020, was performed. Institutional review board approval was not required due to all extracted information being part of the public domain. Data collection started on April 8, 2020 (the day the 2020 ASCRS Virtual Meeting was announced) and ended on May 31, 2020 (2 weeks postconference). All tweets and their associated metadata were compiled using ForSight, social media analytics software by Crimson Hexagon/Brandwatch. The software allows industries to track insight into their products in the virtual space. Tweets were compiled through a search using the hashtag, #ASCRSVirtualMeeting, and the ASCRS Twitter account, @ASCRSTweets, because investigators determined these to be directly associated with the conference. A total of 737 tweets were identified.

For each tweet, the following data were collected: the time and date when the tweet was shared, the type of post (original tweet, retweet, or reply), and the author's username, name, country of origin, state, region, city, sex, number of posts shared, number of followers, and the Influence Score. The Influence Score, as determined by a Crimson Hexagon algorithm, is based on the number of times a user has been retweeted or mentioned. In addition, a coding scheme was developed to record whether the tweet had any mentions (use of the @ symbol to get attention from other Twitter users), the total number of mentions, use of a URL (hyperlink), use of media (defined as a photograph, video, or GIF), use of distinct hashtags (outside of the ones used to capture tweets into our database), and whether a disease was mentioned (in the text or media of the tweet). All investigators met to review and generate a coding key for these metrics, in addition to categorizing each Tweet's content and type of author account (Table 1).

Table 1. - Coding Scheme and Examples of Tweets and Types of Accounts.
Category of tweet Code and definition Examples
(1) Social—social aspects of conference and conversations between users @ASCRStweets Great job in the circumstances! Congratulations to you all
(2) Conference promotion—general promotion about conference and events surrounding conference We're looking forward to #ASCRSVirtualMeeting offering live and on-demand educational sessions @ASCRStweets!
(3) Science promotion—sharing results of research and promoting data shared during conference Amniotic membrane effective in GVHD-induced dry eye disease @ASCRSTweets #ASCRSVirtualMeeting https://t.co/8QpzvRSsXo
(4) Self-promotion—mention of individual’s research, interests, and ideas RT @MoranEyeCenter Congratulations to Team Moran: *** Liliana Werner, MD, PhD, and Nick Mamalis, MD, winners for their “New Pupil Expander Used for Capsular Bag Support” in the Instruments & Devices/IOLs category for the 38th ASCRS Film Festival! @ASCRStweets
(5) Industry—related to a certain industry and/or promoting their products at the conference We are ready to welcome you at ASCRS 2020 virtual meeting. Visit us at https://t.co/c3HKwBwf0t and book a meeting to know more about our latest development and future plans. #CLEAR #ziemer #femtoldvz8#galileiG6 #ASCRSVirtualMeeting @ASCRStweets https://t.co/4GbLZNY9Pj
(6) Not categorized—a tweet either inherently related or sharing a link related to the 2020 ASCRS conference but not falling in any of the aforementioned categories Terry Kim, MD, president-elect of the @ASCRStweets and head of cornea and refractive surgery at Duke University Eye Center, discusses the impact of the #coronavirus pandemic and how the center plans to safely implement a #reopening strategy https://t.co/4XP1Rqt1zm
(7) Irrelevant—unrelated to the ASCRS 2020 Virtual Conference Join us for a very special #digitalhealth showcase, sponsored by @aao_ophth and @ASCRStweets! @Eyecelerator @BascomPalmerEye https://t.co/RKanE4dz3s
Account type Code and definition Examples
(1) Individual—a person, group of physicians, hospital, or private clinic posting as a singular entity
(2) Industry—any account associated with healthcare industry and/or marketing
(3) Academia—relating to concerned with the pursuit of research, education, and scholarship

Two coders independently coded all 737 tweets and reviewed data 3 times for accuracy and consistency. The 2 coders went through their assigned tweets twice. A random subset of tweets was then analyzed by a separate coder to ensure agreement with the coding listed. If there was a disagreement, the tweets were brought to discussion to a group and revised. Tweets without an obvious category were also brought to the attention of the group for a group discussion to agree on coding.

Some tweets fell into more than 1 category and were, thus, categorized under both subtypes. Tweets that were categorized as irrelevant (7) or were no longer available (due to being deleted by the user or belonging to a private account) were excluded from the calculations; 501 tweets remained in the final analysis.

ForSight software was used to provide numerous descriptive statistics (https://forsight.crimsonhexagon.com/).7 The software captured all publicly available tweets regarding the ASCRS conference that used the hashtag and/or account as mentioned earlier. ForSight was used to analyze tweets between April 8, 2020, and May 31, 2020, and to produce the following measures: two topic wheels that graphically illustrate the most commonly discussed topics during the study period, the average volume of tweets per day, the total volume of conversation, the sex distribution of Twitter users in the study, the top 50 influencers during the conference, the most active authors during the conference, and the geographical distribution of Twitter activity during the study dates.

Twitter allows users to track the impact of their posts through Twitter analytics. An integral measurement tool is impressions, which tracks how many times a tweet has been viewed. Impressions can be used to track the reach and impact of individual tweets with users. Twitter analytics for the official ASCRS account (@ASCRSTweets) were used to assess total number of impressions for posts by the account during the study period, the conference dates, and the month after the conference and the 2019 conference for comparison.

RESULTS

Overall, 737 tweets were identified that included either the hashtag #ASCRSVirtualMeeting or the account @ASCRSTweets. After removing tweets unrelated to the conference and those from private accounts (and, therefore, unable to be seen by investigators), 501 remained and were included in the final analysis.

The results showed that 146 tweets (29.1%) were shared before, 303 tweets (60.5%) during, and 52 tweets (10.4%) after the conference (Figure 1 and Table 2). There were 167 unique users; 17 countries were represented, with the United States representing 83.8% (n = 299) of the total, followed by the United Kingdom with 3.6% of the total (n = 13) (Table 3).

Figure 1.
Figure 1.:
Tweeting trends from April 8 to May 31, 2020.
Table 2. - Descriptive Information About Tweets (N = 501).
Category n (%)
Original
 Yes 235 (46.9)
Reshare
 Yes 240 (47.9)
Replies
 Yes 26 (5.2)
Timing
 Before conference 146 (29.1)
 During conference 303 (60.5)
 After conferences 52 (10.4)
Category of tweet (multiple possible)
 Social 136 (27.2)
 Conference promotion 315 (62.9)
 Science promotion 137 (27.4)
 Self-promotion 22 (4.4)
 Industry 115 (23.0)
 Not categorized 5 (1.0)
Disease mention (Y/N)
 Yes 141 (28.1)
 No 359 (71.7)
Mentions (Y/N)
 Yes 290 (57.9)
 No 211 (42.1)
No. of mentions (0, 1–2, 3+)
 0 211 (42.1)
 1–2 216 (43.1)
 2+ 74 (14.8)
Use of multimedia
 Yes 299 (59.7)
 No 202 (40.3)
Use of URL
 Yes 297 (59.3)
 No 204 (40.7)
Use of hashtag
 Yes 155 (30.9)
 No 346 (69.1)

Table 3. - Tweets by Country (N = 357).
Tweets by country N (%)
USA 299 (83.8)
UK 13 (3.6)
Ireland 9 (2.5)
Canada 7 (2.0)
Venezuela 6 (1.7)
India 4 (1.1)
Germany 3 (0.8)
Argentina 3 (0.8)
Japan 3 (0.8)
Italy 2 (0.6)
Spain 2 (0.6)
Switzerland 1 (0.3)
Peru 1 (0.3)
Mexico 1 (0.3)
Liberia 1 (0.3)
Hong Kong 1 (0.3)
France 1 (0.3)

The busiest day during the study period was May 16, the first day of the conference, with 191 posts either including the hashtag or mentioning the ASCRS Twitter account. Twitter activity during the second day of the conference stayed consistent with 120 tweets.

Demographics of Users

A total of 167 unique accounts contributed to the Twitter conversation. Of the 501 tweets reviewed, 243 tweets (48.5%) came from private accounts, 116 (23.1%) came from academic institutions, 72 (14.4%) came from ASCRS accounts, 62 (12.4%) came from the industry, and 8 (1.6%) came from professional organizations. Of the 167 unique accounts, 78 accounts had an identified sex, with 51 (65.4%) being male participants and 27 (34.6%) being female participants (Figure 2, A). Of the 188 users with identified age, 33 (94%) were aged 35 years or older, 7 (4%) were aged 25 to 34 years, and 5 (3%) reported as younger than 17 years (Figure 2, B).

Figure 2.
Figure 2.:
Tweeters by identified sex (A). Tweeters by identified age (B).

The most active users were from professional organizations (#1: @ASCRSTweets), ophthalmic publications (eg, EyeWorld magazine and Healio), and personal users. Duke Eye Center was the most active institution contributing to the conference conversation (Figure 3).

Figure 3.
Figure 3.:
Most active authors from April 8 to May 31, 2020.

Content of Twitter Discussion

When analyzed by type of post, 235 (46.9%) were original tweets, 240 (47.9%) were retweets, and 26 (5.2%) were replies (Table 2). Of tweets during the study period, 315 (62.9%) were promoting conference events, 137 (27.3%) shared information about research studies presented at the conference, 136 (27.1%) were social posts (ie, conversations between conference attendees), 115 (23.0%) were from industry sponsors, 22 (4.4%) were self-promotion (eg, advertising about one's presentation), and 5 (1.0%) were not categorized (Table 4).

Table 4. - Number of Tweets Tagged Per Category Before, During, and After the Conference.
Categories Before (n = 146) (%) During (n = 303) (%) After (n = 52) (%) Total (N = 501) (%) Retweets (n = 240) (%)
Social 14 (9.6) 110 (36.3) 12 (23.1) 136 (27.1) 60 (25.0)
Conference promotion 118 (80.8) 176 (58.1) 22 (42.3) 315 (62.9) 166 (69.2)
Science promotion 15 (10.3) 97 (32.0) 24 (46.2) 137 (27.3) 70 (29.2)
Self-promotion 4 (2.7) 15 (5.0) 3 (5.8) 22 (4.4) 7 (2.9)
Industry 49 (33.6) 58 (19.1) 8 (15.4) 115 (23.0) 53 (22.1)
Not categorized 3 (2.1) 2 (0.7) 0 (0) 5 (1.0) 1 (0.4)

When looking only at retweets, the 3 most common categories were conference promotion (166 [69.2%]), science promotion (70 [29.2%]), and social tweets (60 [25%]) (Table 4). Before the conference, from April 8, 2020, to May 15, 2020, 146 tweets were shared: 118 (80.8%) were for conference promotion, 49 (33%) were from industry, 15 (10.3%) were information about research to be presented at the conference, 14 (9.6% were social content, 4 (2.7%) were self-promotion, and 3 (2.1%) were not categorized. During the conference, from May 16, 2020, to May 17, 2020, 303 tweets were shared: 176 (58.1%) were for conference promotion, 110 (36.3%) were social content, 97 (32.0%) were research related, 58 (19.1%) were from industry, 15 (5.0%) were self-promotion, and 2 (0.7%) were not categorized.

After the conference, from May 18, 2020, to May 31, 2020, 52 tweets were shared: 22 (42.3%) were for conference promotion, 24 (46.2%) were information about research studies presented at the conference, 12 (23.1%) were social content, 3 (5.8%3) were self-promotion, and 8 (15.4%8) were from industry, and none (0%) was left uncategorized (Table 4). One hundred forty-one tweets mentioned one or more diseases or conditions, with cataracts being the most commonly tweeted condition (56 [39.7%]), followed by COVID-19 (31 [22.0%]) (Table 5). A topic wheel generated by ForSight showed that commonly cited topics included the Film Festival and videos presented during the conference, the keynote address by Dr. Scott Gottlieb of the U.S. Food and Drug Administration on the COVID-19 crisis, discussions on an all-new digital environment, industry exhibits, and specific references to conference presenters and their institutions (Figure 4).

Table 5. - Tweets Mentioning Diseases (N = 141).
Disease n (%)
Cataracts
 Total 56 (39.7)
 Tweet 37 (26.2)
 Photograph in tweet 18 (12.8)
 Link of tweet 1 (0.7)
COVID-19
 Total 31 (22.0)
Dry eye syndrome
 Total 27 (19.2)
Meibomian gland disease
 Total 19 (13.5)
Glaucoma
 Total 20 (14.2)
 Tweet 13 (9.2)
 Photograph in tweet 7 (5.0)
Astigmatism
 Total 5 (3.6)
Rosacea
 Total 5 (3.6)
Keratoconus
 Total 4 (4.3)
 Tweet 2 (2.8)
 Photograph in tweet 2 (2.8)
Allergic conjunctivitis
 Total (photograph) 1 (0.7)
Chronic blepharoconjunctivitis
 Total 1 (0.7)
Conjunctival hemorrhage
 Total 1 (0.7)
Corneal ectasia
 Total 1 (0.7)
IFIS
 Total (photograph) 1 (0.7)
Pseudoexfoliation
 Total (photograph) 1 (0.7)
Weak zonular fibers
 Total (photograph) 1 (0.7)
IFIS = intraoperative floppy-iris syndrome

Figure 4.
Figure 4.:
Topic wheel: most commonly tweeted topics from April 8 to May 31, 2020.

Engagement with the ASCRS Twitter Account

The ASCRS account earned 283.0K impressions over the study period (Figure 5). This is 58% higher compared with the same time last year and 74% higher compared with that 1 month prior to the announcement of the virtual meeting. Comparing Twitter use on the days of the meeting this year compared with the meeting days last year (May 3 to 7, 2019), Twitter impressions on the ASCRS account increased by 79%.

Figure 5.
Figure 5.:
Twitter impressions from April 8 to May 31, 2020. Source: Twitter.com, @ASCRSTweets.

Use of the #ASCRSVirtualMeeting hashtag when summing up the conference led to the highest number of hashtag clicks. The top 3 posts with the highest engagements and link clicks were regarding (1) the virtual exhibition hall, (2) the keynote speaker session, and (3) the winner of the Film Festival.

DISCUSSION

The ASCRS as a society constantly strives to fulfill its mission of education, advocacy, and philanthropy, and the annual meeting serves as its culmination by providing the opportunity to educate and empower anterior segment surgeons through innovative and collaborative approaches. The launch of the 2020 ASCRS Virtual Meeting sought to maintain this mission while ensuring the safety of the ASCRS membership.

This study, to our knowledge, is the first to describe how users engaged with a virtual ophthalmology meeting through social media, which offers insights into both future conference planners, attendees of both virtual and in-person conferences, and industry sponsors. We examined the most commonly discussed topics, the influential users and how they used social media during the conference, and identified the reach and influence of tweets about the conference. The results of the study demonstrate how the ophthalmology community can use social media during conferences and highlight important themes and potential opportunities for networking through social media.

During the ASCRS Virtual Meeting, most users shared information about conference events and results from research presentations or communicated with each other during the conference. The most popular tweets were those regarding industry or the keynote speeches. Industry representatives used the official meeting hashtag to promote material and products exhibited at the meeting, as indicated by the 9.7% of tweets that were characterized as industry related. Use of the #ASCRSVirtualMeeting hashtag when summing up the conference led to the highest number of hashtag clicks, suggesting that people saw it as a resource for reviewing a condensed version of conference highlights even after the meeting.

Previous studies showed the potential for Twitter to facilitate meaningful exchanges related to conference topics.8 Especially when circumstances prevent meeting in-person, social media might allow for meaningful engagement between speakers and conference attendees. The 79% increase in impressions between this year and last year ASCRS conference might suggest that conference attendees are looking for a simple but effective platform to connect during a virtual conference. This study demonstrates the multitude of ways that attendees and organizers can use social media to create another dimension to the conference experience. By tweeting about a conference in advance, conference attendees can connect with other attendees before the conference starts and expand their network. Using the share function, attendees can also promote events happening during the conference. Twitter might also make it easier to pose questions to conference speakers either through a publicly posted tweet or through its direct messaging function. Twitter users can also look to the professional organization's Twitter page to easily search and bookmark conference events. The creation of a conference hashtag also allows users to connect with the broader conversation regarding the conference and to follow along with the conference activity through the timeline function, which creates a user-driven recap of the conference. Furthermore, conference planners can review social media engagement using measures such as impressions to assess how they increase engagement for future virtual conferences.

In this study, tweets that used the official hashtag garnered more impressions (total views) and higher levels of engagement (clicks, likes, and shares). This suggests that the creation of a standardized hashtag allows people to easily reference discussions and educational conference content even after the meeting.

When considering limitations to this study, it is important to note that we only used 1 social media platform and, as such, did not capture different themes emerging from different platforms such as Facebook, Instagram, or email chains. Furthermore, our search criteria collected tweets that either used the conference hashtag or mentioned the ASCRS accounts and, therefore, might have missed conversations about the conference that did not use our selection criteria. Future studies might include broader search criteria and extend the use to other social media platforms. In addition, our demographics (age, sex, and location) might be skewed as they depended on identifiable information available Twitter. Finally, there is a chance that tweets were miscategorized, despite several quality control steps that were used to ensure data integrity and validate coding.

Although COVID-19 might have changed the way in which we interact in conferences, this report demonstrates that social media still offers the opportunity for the networking that facilitates the creation of community, collaboration, and dissemination of research that is so integral to the success of a conference. Moving forward, conference planners might benefit from studying trends related to ophthalmology and conferences on social media to better understand the ways in which social media can effectively spread and complement conference content. Furthermore, this study highlights the strong virtual community that ophthalmologists have created around the globe, which has only been strengthened by the COVID-19 pandemic.

WHAT WAS KNOWN

  • COVID-19 has changed how the ophthalmology community meets.
  • Social media allows for the medical community to communicate in real time to disseminate new information and make new connections.
  • Because conferences transition to virtual platforms, it is important to understand and characterize the role that social media can play to enhance the virtual conference experience.

WHAT THIS PAPER ADDS

  • Conference attendees turned to social media to augment their conference experience. A consolidated hashtag made it easy to follow along with conference activities and recruited nonconference goers.
  • The creation of a virtual exhibit hall was also a highlight to the conference experience and one that was highly shared on Twitter.
  • Social media will continue to play a role in the conference experience, and it is important to create a unified social media platform (eg, hashtag and active accounts) to promote a robust and easily-promoted conference experience.

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