Health care providers have become increasingly aware of poor patient u
nderstanding of their illnesses and their treatments. A major, increas
ingly recognized factor in poor understanding and compliance is the lo
w literacy skills of 90 million Americans. This article reviews the li
terature on tile relationship between patients' literacy skills and th
e literacy levels required to read educational health care materials,
and applies a similar analysis to commonly used ophthalmic patient-edu
cational materials. Understanding the relationships between patient li
teracy skills and health care utilization will be critical in improvin
g thee efficiency) of the health care system. (C) 1997 by Elsevier Sci
ence Inc. All rights reserved.