Sir,Bandhu and Raje have outlined the results of an interesting study on their experience of using E-learning as an instructional method in ophthalmology.[1] And the results of their study are clear, E-learning is acceptable to undergraduate medical students as a method of instruction. As with most research, the most important question for the interested reader is where the research findings will lead next.Certainly it is telling that the educational topic was the subject of ophthalmology. It is likely that, as with all methods of instruction, E-learning will suit some specialties and subjects more than others. There is the reason to be optimistic about ophthalmology. This is an image rich specialty, and relatively simple E-learning resources can be used to demonstrate key images in ophthalmology that will help learners improve their diagnostic skills. However, this is really just the start of the learning journey. Modern technology and the near ubiquitous availability of broadband internet means that high definition multimedia learning resources that are based on defined learner needs can be created and made available online.[23]These resources have the potential to demonstrate clinical signs and simple clinical procedures. Similarly video based learning resources can be used to show consultations – where students can learn how best to communicate with patients who have eye complaints. For more complicated problems, multidisciplinary case conferences could be videoed and made available online thus enabling students to learn team working skills.There are much potential and many possibilities in E-learning – the main limitation is likely to be cost. It is interesting therefore that, in Bandhu and Raje's study, some students thought that E-learning would be an expensive method of instruction. Put simply there are conflicting views in this area.[3]Many feel that E-learning has the potential to save costs – not least because of the fact that it saves the many aspects of face to face learning that are rendered unnecessary by the new medium. For example, E-learning means that the expense of travelling to educational conferences is no longer necessary. On the other hand, there are certain costs that are peculiar to E-learning. For example, there is the cost of the creation of content and the cost of technology so that users can access this new content. Both of these balancing factors need to be taken into account when considering the effectiveness and indeed the cost effectiveness of E-learning.However, if costs can be held within reasonable limitations then there is every reason to believe that E-learning has much potential as an instructional method in ophthalmology.Yours Sincerely,