The ETDRS system of measuring visual acuity, employs Sloan letters, a spacing of 0.1 log unit in optotype size between lines, and proportional spacing between lines. The Early Treatment of Diabetic Retinopathy (e-ETDRS) 4 protocol is a “gold standard” for visual acuity assessment for adults. Some of the other ideal requirements such an app would need to fulfill include: display presentation to meet the limited screen space available on smart phones, customizable for use at a variety of test distances based on testing requirements, input method such as a touch screen interface to avoid the need for a separate remote device, validated logic protocol to standardize testing, adaptive protocol which responds to subject’s actual responses to ensure adherence to the validated protocol and mimic a skilled professional’s testing paradigm regardless of user experience, automated data recording, automated results with result interpretation, data retention for monitoring of visual acuity changes over time, precise recording of every presentation point, logMAR reporting for accurate interpolation between lines, Early Treatment of Diabetic Retinopathy Study (ETDRS) or HOTV validated optotypes including crowding bars when not displaying traditional rows of letters, telemedicine compatible, widely available and, affordable, etc. The limitations of available apps for use in telehealth, and the fact that most vision assessments outside of research protocols are still performed subjectively suggests that there is a need for a new, standardized visual acuity testing app that is reproducible, fast, and easy to use in a variety of different vision testing venues. Interestingly, none of the apps qualified for telemedicine purposes. While there are a few apps that fill the space, a recent study that investigated the accuracy of visual acuity by testing apps and assessed their usability for telehealth reported that most of the apps tested had large errors with the optotype and testing distance. This may be of particular concern for visual acuity assessments performed outside of an eye professional’s office. Due to variations in the recognition of different optotypes, attention of the subject, or other factors, individuals may misidentify certain optotypes above threshold while correctly identifying only some optotypes at threshold making final visual acuity determination difficult to interpret. The examiner administering the used test must decide which optotypes to display and its sequence. However, visual acuity screenings at schools, community settings, primary care offices, home testing, and even at eye doctor’s offices may often not be standardized. This typically involves a subjective assessment using a standard chart like Snellen, which has been replaced by LogMAR charts in most parts of the world. Now, I will start.I spy with my little eye.Assessment of visual acuity is an important component of any comprehensive eye examination or vision screening. So, when printable i-spy cards made a comeback my little 6-year-old heart rejoiced! While I am working on some of my own cards, I wanted to gather up some fabulous i-spy printable cards for you! All here together for you to pick and choose from! The simple things, like nature walks and games of i-spy, are the memories that I carry in my heart. These games would continue to the car and we would spy things in and out of the car as we drove to our next destination. My mom could always find the best things to spy. When we were waiting in an arduously long line we would play wicked cool games of i-spy.

I had many beautiful rocks, a collection of perfectly formed, and subsequently dried, leaves, and a host of twigs that we had imagined looked like everything from a rocketship to a brave knight's sword.

My mother taught me to find joy in the common-place.

We would go on 'nature walks' and I would bring along a brown paper lunch sack to collect all the 'goodies' that we found. When I was a little girl my mom had all the best ideas to keep me engaged, happy, and satisfied.

Eyespy world