JMIR Publications

ABSTRACT

Background:

Mobile visual acuity (VA) applications have emerged as valuable tools in both clinical and home settings, particularly in the context of expanding teleophthalmology. Despite the growing number of apps available to measure visual acuity, studies evaluating their overall quality, functionality, and clinical relevance are limited.

Objective:

The purpose of this study was to systematically evaluate the quality and features of mobile VA apps available on iOS and Android platforms using the clinically validated Mobile App Rating Scale (MARS).

Methods:

A comprehensive search of the Google Play Store and Apple App Store was conducted between January and March 2024 using standardized search terms. Eligible apps included free, English-language VA testing tools not requiring external devices. App characteristics and features were extracted. Each app was independently evaluated by two trained reviewers using MARS, which rates engagement, functionality, aesthetics, information quality, and subjective quality on a 5-point scale.

Results:

Of the 725 apps initially identified, 44 met inclusion criteria, with 23 from the Google Play Store and 21 from the Apple App Store. The most common VA test optotypes used were Tumbling E (n=21; 48%), Snellen Chart (n=18; 41%), and Landolt C (n=14; 32%). Common supplemental features included color vision testing (n=20; 46%), astigmatism tests (n=13; 30%), Amsler grid (n=13; 30%), and contrast testing (n=12; 28%). The average MARS scores were comparable across platforms: 3.04 (SD 0.80) for Android and 3.02 (SD 0.84) for iOS. Functionality received the highest ratings (3.65 Android, 3.71 iOS), while subjective quality received the lowest (2.09 Android, 2.21 iOS). Few apps had undergone clinical validation. Only Apple App Store apps demonstrated significant correlations between MARS scores and app store star ratings.

Conclusions:

VA apps exhibited considerable heterogeneity in quality, functionality, and clinical utility. Total mean MARS scores were similar between Google Play Store and Apple App Store, suggesting that neither platform consistently offers superior app quality. While many apps are technically sound, low subjective quality scores and a lack of clinical validation limit their current utility in professional practice. These findings underscore the need for more rigorous app development and validation standards to improve their relevance and reliability in teleophthalmology.