Research Article: “Smart Eye Camera”: An innovative technique to evaluate tear film breakup time in a murine dry eye disease model

Date Published: May 9, 2019

Publisher: Public Library of Science

Author(s): Eisuke Shimizu, Yoko Ogawa, Hiroyuki Yazu, Naohiko Aketa, Fan Yang, Mio Yamane, Yasunori Sato, Yutaka Kawakami, Kazuo Tsubota, Meng C. Lin.


Tear film breakup time (TFBUT) is an essential parameter used to diagnose dry eye disease (DED). However, a robust method for examining TFBUT in murine models has yet to be established. We invented an innovative device, namely, the “Smart Eye Camera”, which addresses several problems associated with existing methods and is capable of evaluating TFBUT in a murine DED model. We compared images taken by existing devices and the Smart Eye Camera in a graft-versus-host disease-related DED murine model. We observed that the quality of the images obtained by the Smart Eye Camera were sufficient for practical use. Moreover, this new technique could be used to obtain measurements for several consecutive ocular phenotypes in a variety of environments. Here, we demonstrate the effectiveness of our new invention in the examination of ocular phenotypes, including TFBUT in a murine model. We highlight the potential for future translational studies adopting the Smart Eye Camera in clinical settings.

Partial Text

Dry eye disease (DED) is a common ocular disease and a major reason for visits to ophthalmologists. It is reported that 7.4–33.4% of the worldwide population has been diagnosed with DED [1], comprising an estimated 560 million to 2.54 billion DED patients [2]. Recently, an article by the International Dry Eye Work Shop on the role of the tear film in DED was published [3]. DED is characterized by the loss of tear volume, rapid breakup of the tear film, and evaporation of tears. It is proposed that tear film breakup time (TFBUT) is the one of the core objective findings in DED diagnosis, and it induces declines in visual performance and optical quality [3]. For example, a previous article reports that DED decreases human annual labor productivity by $6,160 per year per capita [4]. Because of the increased incidence of this disease in Asia, the diagnostic criteria of DED were renewed by the Asia Dry Eye Society [5]. The renewed criteria highlight an essential role of TFBUT assessment and defined TFBUT as the most important objective phenotype in DED patients. Despite the importance of TFBUT assessment in humans, a robust method of measuring TFBUT is not established in murine DED models.

The purpose of this study was to demonstrate the applicability of our invention in a mouse model. Therefore, our first step is to confirm the success of producing the GVHD-related DED model. This model is characterized by body weight loss, shortening of TS, and exacerbation of corneal epithelitis, which is reflected by the CFS [7]. We obtained similar results in body weight [12, 22], TS [12, 14], and CFS [7] when compared to those in our previous studies–in both the difference ratios compared to those at the baseline (Fig 2, Fig 4 and S2 Fig) and in the numeric values (S5 Fig. Moreover, according to our results, TFBUT in the GVHD-related DED model was decreased when compared to that in the normal and the non-GVHD groups (Fig 3 and S5 Fig), which indicated that the TFBUT transition was similar with TS and opposite to CFS. A possible explanation of these consecutive results involves the use of irradiation before BMT and engraftment of donor cells to the recipients. Ten days after BMT, donor cells were engrafted in the recipients. After 21 days (from BMT), allogenic recipients presented with GVHD. Therefore, exposure to these conditions may shorten TFBUT and increase the CFS. Summarizing the first step, we verified the success of producing a GVHD-related DED model from our results.

We invented a new device, the Smart Eye Camera, and demonstrated its applicability in a GVHD-related DED murine model. It is capable of aiding in the evaluation of consecutive ocular phenotypes such as TFBUT and CFS. However, due to the small sample size of this investigational pilot study, further studies are needed. Our future aim is to translate this novel technique into clinical use. We believe that the use of Smart Eye Camera can harness the benefits of widespread smartphone use and make a positive contribution to the healthcare industry.