Sir,

We read with interest the article by Tofigh et al,1 which found a disparity in visual acuity measurement between the Eye HandBook (EHB) smartphone application compared to the conventional near vision card. The modern smartphone has become a ubiquitous possession in the developed world, with various applications granting the devices multifunctional utility to their users.2 In ophthalmology alone, there has been an extraordinary 12-fold increase in the number of applications produced in recent years.3 This gives the smartphone a potentially important role for both patients and physicians.

However, alongside this rapid expansion, studies suggest a worryingly small portion are actually affiliated with an academic institution or association. Results from one study demonstrated only 68 ophthalmology apps, out of 182 analyzed, had documented professional involvement,3 which correlates with the findings of a study investigating a wider range of surgical specialties.4 Therefore, the approach by Tofigh et al in validating this smartphone application is indeed welcome and needed. However, the study’s own findings raise the point that professional involvement may not be enough, which is another point overlooked in this field of research. The EHB is one of the most popular ophthalmology applications, endorsed by the American Academy of Ophthalmology,5 yet this study highlights legitimate concerns regarding its accuracy in measuring visual acuity.

Beyond purely top–down regulation, we feel that encouraging an attitude of evidence-based application production is now needed. Although this is being adopted in the production of some applications, there is still much work to be done in ensuring that further applications are medically accurate and clinically robust. There is a risk that avoiding such an approach may lead to the rapid dissemination of outdated or outright false information through haphazard and unregulated application production. With the potential for new applications to quickly land directly into the hands of patients and doctors alike, we call for more validation of smartphone applications and for future research to foster an attitude of evidence-based application production.