June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Maximum blink interval (MBI) measured through the DryEyeRhythm app is reliable and valid
Author Affiliations & Notes
  • Jaemyoung Sung
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
    University of South Florida Morsani College of Medicine, Tampa, Florida, United States
  • Kenta Fujio
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
    Digital Medicine, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Ken Nagino
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
    Digital Medicine, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Tianxiang Huang
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
    Digital Medicine, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Yasutsugu Akasaki
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
    Digital Medicine, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Yuichi Okumura
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
    Digital Medicine, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Akie Midorikawa-Inomata
    Hospital Administration, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Keiichi Fujiomoto
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
    Digital Medicine, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Atsuko Eguchi
    Hospital Administration, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Maria Miura
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
    Digital Medicine, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Shokirova Hurramhon
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Alan Yee
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Kunihiko Hirosawa
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
    Digital Medicine, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Mizu Ohno
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
    Digital Medicine, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Akira Murakami
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
    Digital Medicine, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Takenori Inomata
    Ophthalmology, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
    Digital Medicine, Juntendo Daigaku, Bunkyo-ku, Tokyo, Japan
  • Footnotes
    Commercial Relationships   Jaemyoung Sung None; Kenta Fujio None; Ken Nagino None; Tianxiang Huang None; Yasutsugu Akasaki Johnson&Johnson, Code F (Financial Support); Yuichi Okumura InnoJin Inc., Code O (Owner); Akie Midorikawa-Inomata InnoJin Inc., Code O (Owner); Keiichi Fujiomoto None; Atsuko Eguchi None; Maria Miura None; Shokirova Hurramhon None; Alan Yee None; Kunihiko Hirosawa None; Mizu Ohno None; Akira Murakami None; Takenori Inomata Johnson&Johnson Vision Care, SEED Co. Ltd., Novartis Pharma K.K., Koma Company Ltd., Santen Pharmaceutical Co. Ltd., Code F (Financial Support), InnoJin Inc., Code O (Owner)
  • Footnotes
    Support  [JST COI JPMJCER02WD02], [JSPS KAKENHI 20KK0207, 20K23168, 21K17311, 21K20998, 22K16983]
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 3997. doi:
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    • Get Citation

      Jaemyoung Sung, Kenta Fujio, Ken Nagino, Tianxiang Huang, Yasutsugu Akasaki, Yuichi Okumura, Akie Midorikawa-Inomata, Keiichi Fujiomoto, Atsuko Eguchi, Maria Miura, Shokirova Hurramhon, Alan Yee, Kunihiko Hirosawa, Mizu Ohno, Akira Murakami, Takenori Inomata; Maximum blink interval (MBI) measured through the DryEyeRhythm app is reliable and valid. Invest. Ophthalmol. Vis. Sci. 2023;64(8):3997.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Current gold standard for dry eye diagnosis highly recommends evaluating the tear film, which typically involves tear film break up time visualized by fluorescein staining. Maximum blink interval (MBI) has been posited as a non-invasive proxy of tear film stability, showing satisfactory diagnostic capabilities for dry eye when assessed with subjective symptoms. However, previous studies measured MBI through slit lamp microscopy, and a formal evaluation of app-based MBI detection has not been performed. Using DryEyeRhythm, an in-house mobile health (mHealth) app for dry eye research, its reliability and validity of MBI measurements were investigated for implementation of non-invasive dry eye diagnosis.

Methods : This study was designed as a single-center prospective study involving 83 participants with three MBI measurements: 1) app-based detection (iOS and Android), 2) microscopy-based, and 3) manual measurement. For app-based MBI detection, a blink sensoring function of DryEyeRhythm was used. Reliability was assessed by analyzing internal consistency and agreement based on the mode of MBI measurement through Cronbach’s alpha and intraclass correlation coefficient (ICC), respectively. Discriminant validity for dry eye and healthy cohorts was measured. Bland-Altman analysis was used to assess the agreement between platforms.

Results : 51 out of 83 (61%) participants had clinically diagnosed DED in this study. For both iOS and Android, app-based MBI was significantly shorter for the DED cohort compared to healthy participants as shown in Figure 1. A similar pattern was observed with the manually measured cohort. Cronbach’s alpha were above 0.8 for six combinations of modes as shown in Figure 2. ICC values (95% CI) were above 0.7 in iOS [0.996 (0.994–0.998) and 0.998 (0.997–0.999)] and visually confirmed MBIs. Bland–Altman analysis showed biases of -0.08 (LoA: -0.76–0.60) and -0.09 (LoA: -0.63–0.45) between app-based and manual MBIs for iOS and Android, respectively.

Conclusions : Our findings indicate that the DryEyeRhythm application is a reliable and valid tool with the advantage of being a non-invasive and non-contact method for MBI measurements, which can assist in providing accessible DED detection and management with a wider outreach. This may have implications for accelerating a paradigm shift of healthcare that underscores the role of preventive and population medicine using principles of mHealth.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

 

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