Validated Apps for Testing Vision

I recently read the manuscript ‘Undermining a common language: Smartphone applications for eye emergencies’, I prepared a Letter to the Editor for clarifying some issues about our Apps for testing vision. Unfortunately, the editor answered that no letters were admitted after one month of publication of the original source. Therefore, we decided to publish the letter here.

 Correspondence: ‘Undermining a common language: Smartphone applications for eye emergencies’

I read with interest the article ‘Undermining a common language: Smartphone applications for eye emergencies’.¹ This is a very interesting and required work whose findings can be transferable to any eye clinical practice. This article deals with the issue of a growing of applications (apps) for testing vision that might be not reliable because of lack of evidence of a previous validation. However, the authors attribute the lack of validation to the fact that it was not cited in its online store or it was not found any reference after searching in medical databases.

Authors failed to find for the evidence at least in one of the cited authors, Manuel Rodríguez-Vallejo who probably is one of the authors that has conducted more scientific publications about vision testing with apps.^2–4 In fact, authors qualified AmblyopiaVA, StereoTAB and ClinicCSF as “no measures of validation internal or external noted” but all have been previously validated,^5–7 and even used in studies not conducted by the author of the apps.^8,9

Another app not cited in this manuscript for measuring Defocus Curves (Multifocal Lens Analyzer)¹⁰ has been also validated and qualified by the magazine “Cataract & Refractive Surgery Today” in the Top 5 of the special volume “Eyes for Innovation”.¹¹ The use of this app in clinical research has grown in the last years.^12–15

Despite none of the current references were cited by the authors, I completely agree with the main conclusion on the manuscript: “Despite the bright future for smartphone technology, mobile device applications in their current state are not suitable for emergency room ophthalmologic assessment.” However, the reason is not because a validation has not been conducted, at least in the apps developed by Manuel Rodriguez-Vallejo. The main reason is that the current purpose of these apps is to conduct clinical research in vision sciences, usually by Ophthalmologists or Optometrists, and not for medical purposes or for the benefit of individual patients. On the other hand, they are intended to evaluate the results along with a sample of patients in order to conduct research.

References

1. Charlesworth JM, Davidson MA. Undermining a common language: Smartphone applications for eye emergencies. Med Devices Evid Res. 2019;12:21-40. doi:10.2147/MDER.S186529
2. Rodríguez-Vallejo M, Monsoriu JA, Furlan WD. Inter-display reproducibility of contrast sensitivity measurement with iPad. Optom Vis Sci. 2016;93(12):1532-1536.
3. Rodríguez-Vallejo M. Comment on: ‘Effectiveness of a smartphone application for testing near-visual acuity.’ Eye. 2016;30:898-899.
4. Rodríguez-Vallejo M. Comment on: ‘The Eye Phone Study: reliability and accuracy of assessing Snellen visual acuity using smartphone technology.’ Eye. 2015;29:1627.
5. Rodríguez-Vallejo M, Llorens-Quintana C, Furlan WD, Monsoriu JA. Visual acuity and contrast sensitivity screening with a new iPad application. Displays. 2016;44:15-20. doi:10.1016/j.displa.2016.06.001
6. Rodríguez-Vallejo M, Ferrando V, Montagud D, Monsoriu JA, Furlan WD. Stereopsis assessment at multiple distances with an iPad application. Displays. 2017;50:35-40. doi:10.1016/j.displa.2017.09.001
7. Rodríguez-Vallejo M, Remón L, Monsoriu JA, Furlan WD. Designing a new test for contrast sensitivity function measurement with iPad. J Optom. 2015;8:101-108.
8. Al-Saud LM, Mushtaq F, Mirghani I, et al. Drilling into the functional significance of stereopsis: the impact of stereoscopic information on surgical performance. Ophthalmic Physiol Opt. 2017;37(4):498-506. doi:10.1111/opo.12393
9. Morais R, Miguel A, Monteiro D, Cassandra C, Poças IM. Estudo comparativo da estereopsia com três testes diferentes: tno®, fly stereo acuity test® e stereotab® em estudantes do ensino superior. Saúde Tecnol. 2016;14:12-18.
10. Fernández J, Rodríguez-Vallejo M, Tauste A, Albarrán C, Basterra I, Piñero D. Fast Measure of Visual Acuity and Contrast Sensitivity Defocus Curves with an iPad Application. Open Ophthalmol J. 2019;13(1):15-22.
11. Fernández J, Rodríguez-Vallejo M, Martínez J. Bridging the gap between lab and clinical practice in assessing multifocal IOLs. Cataract & Refractive Surgery Today. http://crstodayeurope.com/articles/2016-feb/bridging-the-gap-between-lab-and-clinical-practice-in-assessing-multifocal-iols/. Published 2016. Accessed October 26, 2016.
12. Fernández J, Rodríguez-Vallejo M, Martínez J, Tauste A, Piñero DP. Above-average defocus curves in photopic and mesopic vision with multifocal intraocular lenses after laser assisted in situ keratomileusis. Int J Ophthalmol. 2017;10(10):1620-1623. doi:10.18240/ijo.2017.10.23
13. Fernández J, Rodríguez-Vallejo M, Martínez J, Tauste A, Piñero DP. Biometric Factors Associated with the Visual Performance of a High Addition Multifocal Intraocular Lens. Curr Eye Res. 2018;43(8):998-1005. doi:10.1080/02713683.2018.1478981
14. Fernández J, Rodríguez-Vallejo M, Martínez J, Tauste A, Piñero DP. Standard Clinical Outcomes With a New Low Addition Trifocal Intraocular Lens. J Refract Surg. 2019:Accepted-Ahead of print April 2019.
15. Calvo-Sanz JA, Sánchez-Tena MA. Characterization of optical performance with defocusing curve: Analysis of two refractive intraocular lens models with high and medium addition. J Optom. November 2018. doi:10.1016/j.optom.2018.10.003