{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:51:05Z","timestamp":1791269465708,"version":"4.1.0"},"reference-count":69,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eye"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The purpose of this review is to\u00a0 describe integrated technologies for blink analysis and their utility in evaluating ocular surface diseases. A literature search was conducted using PubMed, Embase, and CENTRAL from January 1, 2000, to August 17, 2025. Search terms included \u201cEye Blink\u201d, \u201cBlink\u201d, \u201cBlinking\u201d, \u201cDevice\u201d, \u201cTechnology\u201d, \u201cAppliance\u201d, and\u00a0\u201cApplication\u201d. We included studies describing the use of integrated technologies to capture and analyse blink metrics for the evaluation of dry eye disease and other ocular surface conditions. Publications describing technical engineering aspects\u00a0or technologies without evaluation of ocular surface diseases were excluded. Findings from relevant studies were extracted and compared. Of 3275 identified records, 42 met inclusion criteria. We evaluated the use of 9 technologies. These comprised desk-bound devices(Intelligent Vision Sensor, LipiView\u2122, and IDRA)\u00a0,\u00a0wearable devices\u00a0(Wink Glass, Blink-sensing Glasses),\u00a0and smartphone or computer applications(HealthyRoad, DryEyeRhythm, Dry eye or not? and EyeScore)\u00a0. LipiView\u2122 and IDRA were most commonly studied. Blink rate and partial blink rate were the most commonly analysed parameters, and DED was the most commonly evaluated ocular surface condition. Consistent with existing literature, studies demonstrated associations between increased partial blink rates and ocular surface compromise. There was however\u00a0heterogeneity in methods of blink analysis and insufficient validation of the accuracy and diagnostic ability of measured blink parameters for ocular surface conditions. Integrated blink analysis technologies are promising for the assessment of ocular surface diseases. Further studies are needed to evaluate the validity, reliability, and clinical utility of these technologies.<\/jats:p>","DOI":"10.1038\/s41433-026-04873-8","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:15:27Z","timestamp":1791220527000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A scoping review of integrated blink analysis technologies for ocular surface diseases"],"prefix":"10.1038","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0470-9725","authenticated-orcid":false,"given":"Chee Wui","family":"Ong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanche Xiaohong","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9532-7572","authenticated-orcid":false,"given":"Sanjiv K.","family":"Bhatia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tjaart","family":"van der Walt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tareq","family":"Nabhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2219-3184","authenticated-orcid":false,"given":"Chris Hong Long","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"4873_CR1","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/S1542-0124(11)70007-6","volume":"9","author":"AAV Cruz","year":"2011","unstructured":"Cruz AAV, Garcia DM, Pinto CT, Cechetti SP. Spontaneous eyeblink activity. Ocul Surf. 2011;9:29\u201341. https:\/\/doi.org\/10.1016\/S1542-0124(11)70007-6.","journal-title":"Ocul Surf"},{"key":"4873_CR2","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/s0002-9394(14)71639-3","volume":"124","author":"K Nakamori","year":"1997","unstructured":"Nakamori K, Odawara M, Nakajima T, Mizutani T, Tsubota K. Blinking is controlled primarily by ocular surface conditions. Am J Ophthalmol. 1997;124:24\u201330. https:\/\/doi.org\/10.1016\/s0002-9394(14)71639-3.","journal-title":"Am J Ophthalmol"},{"key":"4873_CR3","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.jtos.2023.05.011","volume":"29","author":"A Oganov","year":"2023","unstructured":"Oganov A, Yazdanpanah G, Jabbehdari S, Belamkar A, Pflugfelder S. Dry eye disease and blinking behaviors: a narrative review of methodologies for measuring blink dynamics and inducing blink response. Ocul Surf. 2023;29:166\u201374. https:\/\/doi.org\/10.1016\/j.jtos.2023.05.011.","journal-title":"Ocul Surf"},{"key":"4873_CR4","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1007\/s00417-021-05490-9","volume":"260","author":"C Talens-Estarelles","year":"2022","unstructured":"Talens-Estarelles C, Esteve-Taboada JJ, Sanchis-Jurado V, Pons \u00c1M, Garc\u00eda-L\u00e1zaro S. Blinking kinematics characterization during digital displays use. Graefes Arch Clin Exp Ophthalmol. 2022;260:1183\u201393. https:\/\/doi.org\/10.1007\/s00417-021-05490-9.","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"4873_CR5","doi-asserted-by":"publisher","first-page":"2701","DOI":"10.1007\/s00417-020-04782-w","volume":"258","author":"V Sanchis-Jurado","year":"2020","unstructured":"Sanchis-Jurado V, Talens-Estarelles C, Esteve-Taboada JJ, Pons \u00c1M, Garc\u00eda-L\u00e1zaro S. Non-invasive high-speed blinking kinematics characterization. Graefes Arch Clin Exp Ophthalmol. 2020;258:2701\u201314. https:\/\/doi.org\/10.1007\/s00417-020-04782-w.","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"4873_CR6","doi-asserted-by":"publisher","unstructured":"Wolffsohn JS, Ben\u00edtez-Del-Castillo J, Loya-Garcia D, Inomata T, Iyar G, Liang L, et al. TFOS DEWS III Diagnostic Methodology. Am J Ophthalmol. 2025: 40451408. https:\/\/doi.org\/10.1016\/j.ajo.2025.05.033.","DOI":"10.1016\/j.ajo.2025.05.033"},{"key":"4873_CR7","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1111\/aos.15150","volume":"100","author":"K Fj\u00e6rvoll","year":"2022","unstructured":"Fj\u00e6rvoll K, Fj\u00e6rvoll H, Magno M, N\u00f8land ST, Dartt DA, Vehof J, et al. Review on the possible pathophysiological mechanisms underlying visual display terminal-associated dry eye disease. Acta Ophthalmol. 2022;100:861\u201377. https:\/\/doi.org\/10.1111\/aos.15150.","journal-title":"Acta Ophthalmol"},{"key":"4873_CR8","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1016\/j.ajo.2013.05.040","volume":"156","author":"M Uchino","year":"2013","unstructured":"Uchino M, Yokoi N, Uchino Y, Dogru M, Kawashima M, Komuro A, et al. Prevalence of dry eye disease and its risk factors in visual display terminal users: the Osaka study. Am J Ophthalmol. 2013;156:759\u201366. https:\/\/doi.org\/10.1016\/j.ajo.2013.05.040.","journal-title":"Am J Ophthalmol"},{"key":"4873_CR9","doi-asserted-by":"publisher","first-page":"e009675","DOI":"10.1136\/bmjopen-2015-009675","volume":"6","author":"R Courtin","year":"2016","unstructured":"Courtin R, Pereira B, Naughton G, Chamoux A, Chiambaretta F, Lanhers C, et al. Prevalence of dry eye disease in visual display terminal workers: a systematic review and meta-analysis. BMJ Open. 2016;6:e009675. https:\/\/doi.org\/10.1136\/bmjopen-2015-009675.","journal-title":"BMJ Open"},{"key":"4873_CR10","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/j.jtos.2017.05.008","volume":"15","author":"JP Craig","year":"2017","unstructured":"Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15:276\u201383. https:\/\/doi.org\/10.1016\/j.jtos.2017.05.008.","journal-title":"Ocul Surf"},{"key":"4873_CR11","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/j.adolescence.2005.08.016","volume":"29","author":"SJ Marshall","year":"2005","unstructured":"Marshall SJ, Gorely T, Biddle SJ. A descriptive epidemiology of screen-based media use in youth: a review and critique. J Adolesc. 2005;29:333\u201349. https:\/\/doi.org\/10.1016\/j.adolescence.2005.08.016.","journal-title":"J Adolesc"},{"key":"4873_CR12","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1016\/j.jtos.2019.05.007","volume":"17","author":"Y Jie","year":"2019","unstructured":"Jie Y, Sella R, Feng J, Gomez ML, Afshari NA. Evaluation of incomplete blinking as a measurement of dry eye disease. Ocul Surf. 2019;17:440\u20136. https:\/\/doi.org\/10.1016\/j.jtos.2019.05.007.","journal-title":"Ocul Surf"},{"key":"4873_CR13","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-75193-4","volume":"10","author":"K Hirosawa","year":"2020","unstructured":"Hirosawa K, Inomata T, Sung J, Nakamura M, Okumura Y, Midorikawa-Inomata A, et al. Diagnostic ability of maximum blink interval together with Japanese version of Ocular Surface Disease Index score for dry eye disease. Sci Rep. 2020;10:1. https:\/\/doi.org\/10.1038\/s41598-020-75193-4.","journal-title":"Sci Rep"},{"key":"4873_CR14","doi-asserted-by":"publisher","first-page":"253","DOI":"10.2147\/OPTH.S39104","volume":"7","author":"PR Johnston","year":"2013","unstructured":"Johnston PR, Rodriguez J, Lane KJ, Ousler G, Abelson MB. The interblink interval in normal and dry eye subjects. Clin Ophthalmol (Auckl, NZ). 2013;7:253. https:\/\/doi.org\/10.2147\/OPTH.S39104.","journal-title":"Clin Ophthalmol (Auckl, NZ)"},{"key":"4873_CR15","doi-asserted-by":"publisher","first-page":"3280","DOI":"10.3758\/s13428-023-02333-9","volume":"56","author":"M Nystr\u00f6m","year":"2024","unstructured":"Nystr\u00f6m M, Andersson R, Niehorster DC, Hessels RS, Hooge ITC. What is a blink? Classifying and characterizing blinks in eye openness signals. Behav Res Methods. 2024;56:3280\u201399. https:\/\/doi.org\/10.3758\/s13428-023-02333-9.","journal-title":"Behav Res Methods"},{"key":"4873_CR16","doi-asserted-by":"publisher","first-page":"467","DOI":"10.7326\/M18-0850","volume":"169","author":"AC Tricco","year":"2018","unstructured":"Tricco AC, Lillie E, Zarin W, O\u2019Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169:467\u201373. https:\/\/doi.org\/10.7326\/M18-0850.","journal-title":"Ann Intern Med"},{"key":"4873_CR17","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.jns.2017.07.035","volume":"380","author":"N Kimura","year":"2017","unstructured":"Kimura N, Watanabe A, Suzuki K, Toyoda H, Hakamata N, Fukuoka H, et al. Measurement of spontaneous blinks in patients with Parkinson\u2019s disease using a new high-speed blink analysis system. J Neurol Sci. 2017;380:200\u20134. https:\/\/doi.org\/10.1016\/j.jns.2017.07.035.","journal-title":"J Neurol Sci"},{"key":"4873_CR18","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1097\/ico.0000000000001841","volume":"38","author":"H Kato","year":"2019","unstructured":"Kato H, Yokoi N, Watanabe A, Komuro A, Sonomura Y, Sotozono C, et al. Relationship between ocular surface epithelial damage, tear abnormalities, and blink in patients with dry eye. Cornea. 2019;38:318\u201324. https:\/\/doi.org\/10.1097\/ico.0000000000001841.","journal-title":"Cornea"},{"key":"4873_CR19","doi-asserted-by":"publisher","unstructured":"Kato H, Yokoi N, Watanabe A, Komuro A, Sonomura Y, Sotozono C, et al. Effect of punctal occlusion on blinks in eyes with severe aqueous deficient dry eye. Diagnostics. 2023;14:38201312. https:\/\/doi.org\/10.3390\/diagnostics14010003.","DOI":"10.3390\/diagnostics14010003"},{"key":"4873_CR20","doi-asserted-by":"publisher","first-page":"1478","DOI":"10.1016\/j.jfma.2020.10.028","volume":"120","author":"HY Weng","year":"2021","unstructured":"Weng HY, Ho WT, Chiu CY, Tsai TY, Chang SW. Characteristics of tear film lipid layer in young dry eye patients. J Formos Med Assoc. 2021;120:1478\u201384. https:\/\/doi.org\/10.1016\/j.jfma.2020.10.028.","journal-title":"J Formos Med Assoc"},{"key":"4873_CR21","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1007\/s10792-022-02521-0","volume":"43","author":"C Xie","year":"2023","unstructured":"Xie C, Liu B, Zhao X, He Q, Liu L, Wei R. Characteristics of the ocular surface in neurotrophic keratitis induced by trigeminal nerve injury following neurosurgery. Int Ophthalmol. 2023;43:1229\u201340. https:\/\/doi.org\/10.1007\/s10792-022-02521-0.","journal-title":"Int Ophthalmol"},{"key":"4873_CR22","doi-asserted-by":"publisher","first-page":"2795","DOI":"10.1007\/s00417-021-05199-9","volume":"259","author":"B Yang","year":"2021","unstructured":"Yang B, Wen K, Li J, Zhang S, Fan Z, Liang X, et al. Quantitative evaluation of lipid layer thickness and blinking in children with allergic conjunctivitis. Graefes Arch Clin Exp Ophthalmol. 2021;259:2795\u2013805. https:\/\/doi.org\/10.1007\/s00417-021-05199-9.","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"4873_CR23","doi-asserted-by":"publisher","first-page":"e800","DOI":"10.1111\/aos.14000","volume":"97","author":"J Park","year":"2019","unstructured":"Park J, Baek S. Dry eye syndrome in thyroid eye disease patients: The role of increased incomplete blinking and Meibomian gland loss. Acta Ophthalmol. 2019;97:e800\u20136. https:\/\/doi.org\/10.1111\/aos.14000.","journal-title":"Acta Ophthalmol"},{"key":"4873_CR24","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.732041","volume":"8","author":"S Zhang","year":"2021","unstructured":"Zhang S, Yan Y, Lu Y, Zhou Y, Fu Y. Effect of transcutaneous upper eyelid blepharoplasty on blink parameters and lipid layer thickness. Front Med. 2021;8:732041. https:\/\/doi.org\/10.3389\/fmed.2021.732041.","journal-title":"Front Med"},{"key":"4873_CR25","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.2147\/OPTH.S299338","volume":"15","author":"AYY Chan","year":"2021","unstructured":"Chan AYY, Chuang JC, Wong VWY. Evaluation of meibomian gland dysfunction among ophthalmic healthcare workers. Clin Ophthalmol. 2021;15:1201\u20136. https:\/\/doi.org\/10.2147\/OPTH.S299338.","journal-title":"Clin Ophthalmol"},{"key":"4873_CR26","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2020.04.014","volume":"44","author":"AD Kim","year":"2021","unstructured":"Kim AD, Muntz A, Lee J, Wang MTM, Craig JP. Therapeutic benefits of blinking exercises in dry eye disease. Cont Lens Anterior Eye. 2021;44:101329. https:\/\/doi.org\/10.1016\/j.clae.2020.04.014.","journal-title":"Cont Lens Anterior Eye"},{"key":"4873_CR27","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.1038\/s41433-018-0149-5","volume":"32","author":"S Zang","year":"2018","unstructured":"Zang S, Cui Y, Cui Y, Fei W. Meibomian gland dropout in Sj\u00f6gren\u2019s syndrome and non-Sj\u00f6gren\u2019s dry eye patients. Eye. 2018;32:1681\u20137. https:\/\/doi.org\/10.1038\/s41433-018-0149-5.","journal-title":"Eye"},{"key":"4873_CR28","doi-asserted-by":"publisher","first-page":"e0265733","DOI":"10.1371\/journal.pone.0265733","volume":"17","author":"C Tangmonkongvoragul","year":"2022","unstructured":"Tangmonkongvoragul C, Chokesuwattanaskul S, Khankaeo C, Punyasevee R, Nakkara L, Moolsan S, et al. Prevalence of symptomatic dry eye disease with associated risk factors among medical students at Chiang Mai University due to increased screen time and stress during COVID-19 pandemic. PLoS One. 2022;17:e0265733. https:\/\/doi.org\/10.1371\/journal.pone.0265733.","journal-title":"PLoS One"},{"key":"4873_CR29","doi-asserted-by":"publisher","first-page":"445","DOI":"10.3341\/kjo.2018.0012","volume":"32","author":"SM Lee","year":"2018","unstructured":"Lee SM, Chung SJ, Lew H. Evaluation of tear film lipid layer thickness measurements obtained using an ocular surface interferometer in nasolacrimal duct obstruction patients. Korean J Ophthalmol. 2018;32:445\u201350. https:\/\/doi.org\/10.3341\/kjo.2018.0012.","journal-title":"Korean J Ophthalmol"},{"key":"4873_CR30","doi-asserted-by":"publisher","DOI":"10.1186\/s12886-022-02365-3","volume":"22","author":"J Lee","year":"2022","unstructured":"Lee J, Hwang G, Ha M, Kim HS, Han K, Na KS. Evaluation of the meibomian glands using the tear interferometer wearing orthokeratology lenses. BMC Ophthalmol. 2022;22:133. https:\/\/doi.org\/10.1186\/s12886-022-02365-3.","journal-title":"BMC Ophthalmol"},{"key":"4873_CR31","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.821106","volume":"9","author":"H Yu","year":"2022","unstructured":"Yu H, Yuan Y, Wu W, Zeng W, Tong L, Zhang Y, et al. Orthokeratology lens wear for 2 years in children did not alter tear film lipid thickness by non-invasive interferometry. Front Med. 2022;9:821106. https:\/\/doi.org\/10.3389\/fmed.2022.821106.","journal-title":"Front Med"},{"key":"4873_CR32","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.2374","volume":"11","author":"J Jang","year":"2021","unstructured":"Jang J, Lew H. Blink index as a response predictor of blepharospasm to botulinum neurotoxin-A treatment. Brain Behav. 2021;11:e2374. https:\/\/doi.org\/10.1002\/brb3.2374.","journal-title":"Brain Behav"},{"key":"4873_CR33","doi-asserted-by":"publisher","first-page":"2379","DOI":"10.3390\/jcm11092379","volume":"11","author":"WL Wu","year":"2022","unstructured":"Wu WL, Chang SW. Dermatochalasis aggravates meibomian gland dysfunction related dry eyes. J Clin Med. 2022;11:2379. https:\/\/doi.org\/10.3390\/jcm11092379.","journal-title":"J Clin Med"},{"key":"4873_CR34","doi-asserted-by":"publisher","first-page":"e113","DOI":"10.1097\/ijg.0000000000002272","volume":"32","author":"C Castro","year":"2023","unstructured":"Castro C, Marta A, Marques JH, Ferreira A, Jos\u00e9 D, Sousa P, et al. Ocular surface changes in primary open angle glaucoma patients treated with topical antihypertensive drugs. J Glaucoma. 2023;32:e113\u201320. https:\/\/doi.org\/10.1097\/ijg.0000000000002272.","journal-title":"J Glaucoma"},{"key":"4873_CR35","doi-asserted-by":"publisher","first-page":"1522","DOI":"10.1111\/jdv.19773","volume":"38","author":"J Nowowiejska","year":"2023","unstructured":"Nowowiejska J, Ordon AJ, Baran A, Izdebska J, Wo\u017aniak B, Kaminski TW, et al. Dry eye syndrome symptoms in patients with psoriasis. J Eur Acad Dermatol Venereol. 2023;38:1522\u201330. https:\/\/doi.org\/10.1111\/jdv.19773.","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"4873_CR36","doi-asserted-by":"publisher","first-page":"3313","DOI":"10.2147\/opth.S480704","volume":"18","author":"B Barbosa Ribeiro","year":"2024","unstructured":"Barbosa Ribeiro B, Marques JH, Baptista PM, Sousa PJM, Pires S, Men\u00e9res P, et al. Corneal epithelial thickness correlation with dry eye symptom severity: a cross-sectional study. Clin Ophthalmol. 2024;18:3313\u201320. https:\/\/doi.org\/10.2147\/opth.S480704.","journal-title":"Clin Ophthalmol"},{"key":"4873_CR37","doi-asserted-by":"publisher","first-page":"2601","DOI":"10.1007\/s10792-021-01819-9","volume":"41","author":"YJ Jeon","year":"2021","unstructured":"Jeon YJ, Song MY, Kim KY, Hwang KY, Kwon YA, Koh K. Relationship between the partial blink rate and ocular surface parameters. Int Ophthalmol. 2021;41:2601\u20138. https:\/\/doi.org\/10.1007\/s10792-021-01819-9.","journal-title":"Int Ophthalmol"},{"key":"4873_CR38","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1097\/ico.0000000000003052","volume":"42","author":"J Rinert","year":"2022","unstructured":"Rinert J, Branger G, Bachmann LM, Pfaeffli O, Iselin K, Kaufmann C, et al. Accuracy of a new noninvasive automatic ocular surface analyzer for the diagnosis of dry eye disease-two-gate design using healthy controls. Cornea. 2022;42:416\u201322. https:\/\/doi.org\/10.1097\/ico.0000000000003052.","journal-title":"Cornea"},{"key":"4873_CR39","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/5804123","volume":"2020","author":"L Vigo","year":"2020","unstructured":"Vigo L, Pellegrini M, Bernabei F, Carones F, Scorcia V, Giannaccare G. Diagnostic performance of a novel noninvasive workup in the setting of dry eye disease. J Ophthalmol. 2020;2020:5804123. https:\/\/doi.org\/10.1155\/2020\/5804123.","journal-title":"J Ophthalmol"},{"key":"4873_CR40","doi-asserted-by":"publisher","first-page":"879","DOI":"10.3109\/02713683.2013.859273","volume":"39","author":"CK Ang","year":"2014","unstructured":"Ang CK, Mohidin N, Chung KM. Effects of wink glass on blink rate, nibut and ocular surface symptoms during visual display unit use. Curr Eye Res. 2014;39:879\u201384. https:\/\/doi.org\/10.3109\/02713683.2013.859273.","journal-title":"Curr Eye Res"},{"key":"4873_CR41","doi-asserted-by":"publisher","DOI":"10.1016\/j.isci.2021.102399","volume":"24","author":"R Chen","year":"2021","unstructured":"Chen R, Zhang Z, Deng K, Wang D, Ke H, Cai L, et al. Blink-sensing glasses: A flexible iontronic sensing wearable for continuous blink monitoring. iScience. 2021;24:102399. https:\/\/doi.org\/10.1016\/j.isci.2021.102399.","journal-title":"iScience"},{"key":"4873_CR42","doi-asserted-by":"publisher","first-page":"4569","DOI":"10.3390\/ijerph20054569","volume":"20","author":"I Lapa","year":"2023","unstructured":"Lapa I, Ferreira S, Mateus C, Rocha N, Rodrigues MA. Real-time blink detection as an indicator of computer vision syndrome in real-life settings: an exploratory study. Int J Environ Res Public Health. 2023;20:4569. https:\/\/doi.org\/10.3390\/ijerph20054569.","journal-title":"Int J Environ Res Public Health"},{"key":"4873_CR43","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1016\/j.jclinepi.2015.01.015","volume":"68","author":"M Segu\u00ed Mdel","year":"2015","unstructured":"Segu\u00ed Mdel M, Cabrero-Garc\u00eda J, Crespo A, Verd\u00fa J, Ronda E. A reliable and valid questionnaire was developed to measure computer vision syndrome at the workplace. J Clin Epidemiol. 2015;68:662\u201373. https:\/\/doi.org\/10.1016\/j.jclinepi.2015.01.015.","journal-title":"J Clin Epidemiol"},{"key":"4873_CR44","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.jtos.2022.04.005","volume":"25","author":"Y Okumura","year":"2022","unstructured":"Okumura Y, Inomata T, Midorikawa-Inomata A, Sung J, Fujio K, Akasaki Y, et al. DryEyeRhythm: a reliable and valid smartphone application for the diagnosis assistance of dry eye. Ocul Surf. 2022;25:19\u201325. https:\/\/doi.org\/10.1016\/j.jtos.2022.04.005.","journal-title":"Ocul Surf"},{"key":"4873_CR45","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-40968-y","volume":"13","author":"K Fujio","year":"2023","unstructured":"Fujio K, Nagino K, Huang T, Sung J, Akasaki Y, Okumura Y, et al. Clinical utility of maximum blink interval measured by smartphone application DryEyeRhythm to support dry eye disease diagnosis. Sci Rep. 2023;13:1. https:\/\/doi.org\/10.1038\/s41598-023-40968-y.","journal-title":"Sci Rep"},{"key":"4873_CR46","doi-asserted-by":"publisher","first-page":"e31011","DOI":"10.2196\/31011","volume":"10","author":"N Kasetsuwan","year":"2022","unstructured":"Kasetsuwan N, Suwan-Apichon O, Lekhanont K, Chuckpaiwong V, Reinprayoon U, Chantra S, et al. Assessing the risk factors for diagnosed symptomatic dry eye using a smartphone app: cross-sectional study. JMIR Mhealth Uhealth. 2022;10:e31011. https:\/\/doi.org\/10.2196\/31011.","journal-title":"JMIR Mhealth Uhealth"},{"key":"4873_CR47","unstructured":"Soukupov\u00e1 T, Cech J. Real-time eye blink detection using facial landmarks. In. 2016 [cited 2025 Jun 22]. Available from: https:\/\/www.semanticscholar.org\/paper\/Real-Time-Eye-Blink-Detection-using-Facial-Soukupov%C3%A1-Cech\/4fa1ba3531219ca8c39d8749160faf1a877f2ced."},{"key":"4873_CR48","doi-asserted-by":"publisher","first-page":"6479","DOI":"10.3390\/jcm12206479","volume":"12","author":"S Zhang","year":"2023","unstructured":"Zhang S, Echegoyen J. Design and Usability Study of a Point of Care mHealth App for Early Dry Eye Screening and Detection. J Clin Med. 2023;12:6479 https:\/\/doi.org\/10.3390\/jcm12206479.","journal-title":"J Clin Med"},{"key":"4873_CR49","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1002\/1348-9585.12027","volume":"61","author":"H Fujita","year":"2019","unstructured":"Fujita H, Sano K, Baba T, Tanaka T, Ohno-Matsui K. Blind working time in visual display terminal users. J Occup Health. 2019;61:175\u201381. https:\/\/doi.org\/10.1002\/1348-9585.12027.","journal-title":"J Occup Health"},{"key":"4873_CR50","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.cmpb.2013.06.003","volume":"112","author":"F Bernard","year":"2013","unstructured":"Bernard F, Deuter CE, Gemmar P, Schachinger H. Eyelid contour detection and tracking for startle research related eye-blink measurements from high-speed video records. Comput Methods Prog Biomed. 2013;112:22\u201337. https:\/\/doi.org\/10.1016\/j.cmpb.2013.06.003.","journal-title":"Comput Methods Prog Biomed"},{"key":"4873_CR51","doi-asserted-by":"publisher","DOI":"10.7717\/peerj-cs.943","volume":"8","author":"C Dewi","year":"2022","unstructured":"Dewi C, Chen RC, Jiang X, Yu H. Adjusting eye aspect ratio for strong eye blink detection based on facial landmarks. PeerJ Comput Sci. 2022;8:e943. https:\/\/doi.org\/10.7717\/peerj-cs.943.","journal-title":"PeerJ Comput Sci"},{"key":"4873_CR52","doi-asserted-by":"publisher","first-page":"e0196125","DOI":"10.1371\/journal.pone.0196125","volume":"13","author":"J Espinosa","year":"2018","unstructured":"Espinosa J, Domenech B, V\u00e1zquez C, P\u00e9rez J, Mas D. Blinking characterization from high speed video records. Application to biometric authentication. PLoS One. 2018;13:e0196125. https:\/\/doi.org\/10.1371\/journal.pone.0196125.","journal-title":"PLoS One"},{"key":"4873_CR53","doi-asserted-by":"publisher","first-page":"20130227","DOI":"10.1098\/rsif.2013.0227","volume":"10","author":"KA Kwon","year":"2013","unstructured":"Kwon KA, Shipley RJ, Edirisinghe M, Ezra DG, Rose G, Best SM, et al. High-speed camera characterization of voluntary eye blinking kinematics. J R Soc Interface. 2013;10:20130227. https:\/\/doi.org\/10.1098\/rsif.2013.0227.","journal-title":"J R Soc Interface"},{"key":"4873_CR54","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1111\/opo.12694","volume":"40","author":"M Navascues-Cornago","year":"2020","unstructured":"Navascues-Cornago M, Morgan PB, Maldonado-Codina C, Read ML. Characterisation of blink dynamics using a high-speed infrared imaging system. Ophthalmic Physiol Opt. 2020;40:519\u201328. https:\/\/doi.org\/10.1111\/opo.12694.","journal-title":"Ophthalmic Physiol Opt"},{"key":"4873_CR55","doi-asserted-by":"publisher","DOI":"10.7717\/peerj-cs.2594","volume":"11","author":"J Xiong","year":"2025","unstructured":"Xiong J, Dai W, Wang Q, Dong X, Ye B, Yang J. A review of deep learning in blink detection. PeerJ Comput Sci. 2025;11:e2594. https:\/\/doi.org\/10.7717\/peerj-cs.2594.","journal-title":"PeerJ Comput Sci"},{"key":"4873_CR56","doi-asserted-by":"publisher","first-page":"e35684","DOI":"10.2196\/35684","volume":"10","author":"HS Kang","year":"2022","unstructured":"Kang HS, Exworthy M. Wearing the future-wearables to empower users to take greater responsibility for their health and care: scoping review. JMIR Mhealth Uhealth. 2022;10:e35684. https:\/\/doi.org\/10.2196\/35684.","journal-title":"JMIR Mhealth Uhealth"},{"key":"4873_CR57","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1097\/j.jcrs.0000000000001081","volume":"49","author":"C Talens-Estarelles","year":"2023","unstructured":"Talens-Estarelles C, D\u00edez-Ajenjo MA, Pons \u00c1M, Peris-Mart\u00ednez C, Garc\u00eda-L\u00e1zaro S. Effects of cataract surgery on blinking. J Cataract Refract Surg. 2023;49:177\u201383. https:\/\/doi.org\/10.1097\/j.jcrs.0000000000001081.","journal-title":"J Cataract Refract Surg"},{"key":"4873_CR58","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1159\/000542985","volume":"68","author":"KK Hei Lai","year":"2025","unstructured":"Hei Lai KK, Hu Z, Chiu JT, Aljufairi FMAA, Sebastian JU, Cheng GPM, et al. Long-term evaluation of ocular surface and meibomian gland function after laser-assisted in situ keratomileusis surgery. Ophthalmic Res. 2025;68:84\u20139. https:\/\/doi.org\/10.1159\/000542985.","journal-title":"Ophthalmic Res"},{"key":"4873_CR59","doi-asserted-by":"publisher","first-page":"2300","DOI":"10.1177\/1120672120969035","volume":"31","author":"JM Lee","year":"2021","unstructured":"Lee JM, Jeon YJ, Kim KY, Hwang KY, Kwon YA, Koh K. Ocular surface analysis: a comparison between the LipiView\u00ae II and IDRA\u00ae. Eur J Ophthalmol. 2021;31:2300\u20136. https:\/\/doi.org\/10.1177\/1120672120969035.","journal-title":"Eur J Ophthalmol"},{"key":"4873_CR60","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s40662-024-00373-6","volume":"11","author":"Y Ren","year":"2024","unstructured":"Ren Y, Wen H, Bai F, Huang B, Wang Z, Zhang S, et al. Comparison of deep learning-assisted blinking analysis system and LipiView interferometer in dry eye patients: a cross-sectional study. Eye Vis. 2024;11:7. https:\/\/doi.org\/10.1186\/s40662-024-00373-6.","journal-title":"Eye Vis"},{"key":"4873_CR61","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/j.jcjo.2019.03.005","volume":"54","author":"YB Chou","year":"2019","unstructured":"Chou YB, Fan NW, Lin PY. Value of lipid layer thickness and blinking pattern in approaching patients with dry eye symptoms. Can J Ophthalmol. 2019;54:735\u201340. https:\/\/doi.org\/10.1016\/j.jcjo.2019.03.005.","journal-title":"Can J Ophthalmol"},{"key":"4873_CR62","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.785901","volume":"8","author":"H Zhao","year":"2021","unstructured":"Zhao H, Wu SN, Cheng Z, Xiao D, Shu HY, Ge QM, et al. Mean tear-film lipid layer thickness and video display terminal time as risk factors for abnormal blinking in children. Front Med (Lausanne). 2021;8:785901. https:\/\/doi.org\/10.3389\/fmed.2021.785901.","journal-title":"Front Med (Lausanne)"},{"key":"4873_CR63","doi-asserted-by":"publisher","first-page":"389","DOI":"10.18240\/ijo.2018.03.07","volume":"11","author":"Y Li","year":"2018","unstructured":"Li Y, Sang X, Yang L, Wang XR, Liu JH, He XJ, et al. Low concentration of sodium hyaluronate temporarily elevates the tear film lipid layer thickness in dry eye patients with lipid deficiency. Int J Ophthalmol. 2018;11:389\u201394. https:\/\/doi.org\/10.18240\/ijo.2018.03.07.","journal-title":"Int J Ophthalmol"},{"key":"4873_CR64","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/3275143","volume":"2020","author":"J Zhang","year":"2020","unstructured":"Zhang J, Wu Z, Sun L, Liu XH. Function and morphology of the meibomian glands using a LipiView interferometer in rotating shift medical staff. J Ophthalmol. 2020;2020:3275143. https:\/\/doi.org\/10.1155\/2020\/3275143.","journal-title":"J Ophthalmol"},{"key":"4873_CR65","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2024.102298","volume":"47","author":"G Zhao","year":"2024","unstructured":"Zhao G, Wang J, Ma Q, Hao Y, Tian L, Jie Y. Comparison of upper eyelid pressure and ocular surface parameters in dry eye disease and benign essential Blepharospasm: a cross-sectional study. Contact Lens Anterior Eye. 2024;47:102298. https:\/\/doi.org\/10.1016\/j.clae.2024.102298.","journal-title":"Contact Lens Anterior Eye"},{"key":"4873_CR66","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-024-19616-1","volume":"24","author":"L Chang","year":"2024","unstructured":"Chang L, Guo Q, Pazo EE, Li F, Zhang Z, Fang Z, et al. Prevalence of dry eye in people over 50 years old in Beichen district, Tianjin city: a cross-sectional population-based survey. BMC Public Health. 2024;24:2111. https:\/\/doi.org\/10.1186\/s12889-024-19616-1.","journal-title":"BMC Public Health"},{"key":"4873_CR67","doi-asserted-by":"publisher","DOI":"10.1186\/s12886-025-03852-z","volume":"25","author":"JS Paik","year":"2025","unstructured":"Paik JS, Kwon MJ, Nam GH, Han K, Whang WJ, Hwang HS, et al. Tear film lipid layer thickness and blink dynamics in patients with blepharospasm. BMC Ophthalmol. 2025;25:22. https:\/\/doi.org\/10.1186\/s12886-025-03852-z.","journal-title":"BMC Ophthalmol"},{"key":"4873_CR68","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1097\/ICL.0000000000001197","volume":"51","author":"J Feng","year":"2025","unstructured":"Feng J, Gu Y, Wen Y, Wang Y, Wang J, Li A, et al. Influence of overnight orthokeratology on ocular surface and blink patterns in children and adolescents-a prospective cohort study. Eye Contact Lens. 2025;51:375\u20139. https:\/\/doi.org\/10.1097\/ICL.0000000000001197.","journal-title":"Eye Contact Lens"},{"key":"4873_CR69","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1097\/ICO.0000000000003473","volume":"43","author":"J Shen","year":"2024","unstructured":"Shen J, Xu Z, Wang Y, Ye J, Wei L, Xia J, et al. Influential signs of dry eye-related ocular symptoms in participants with unstable tear film. Cornea. 2024;43:751\u20136. https:\/\/doi.org\/10.1097\/ICO.0000000000003473.","journal-title":"Cornea"}],"container-title":["Eye"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41433-026-04873-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41433-026-04873-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41433-026-04873-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:02:40Z","timestamp":1791266560000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41433-026-04873-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":69,"alternative-id":["4873"],"URL":"https:\/\/doi.org\/10.1038\/s41433-026-04873-8","relation":{},"ISSN":["0950-222X","1476-5454"],"issn-type":[{"value":"0950-222X","type":"print"},{"value":"1476-5454","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,5]]},"assertion":[{"value":"31 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 August 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 September 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 October 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}}]}}