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Editors Selection IGR 16-4

Clinical Examination Methods: Telemetric tonomtery

Comment by Tony Realini on:

60367 Automated Detection and Quantification of Circadian Eye Blinks Using a Contact Lens Sensor, Gisler C; Ridi A; Hennebert J et al., Translational vision science & technology, 2015; 4: 4

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Gisler and colleagues have conducted an innovative blink detection study utilizing the Triggerfish contact lens system (CLS) that has a number of potentially useful applications. The CLS infers IOP based on changes in corneal curvature detected by a strain gauge embedded in a contact lens. The device samples IOP nearly continuously, obtaining 300 measurements over a 30-second period (10 Hz) every five minutes, and is typically worn for up to 24 hours per session. The device output is a graph in arbitrary units (notably not mmHg) that represents a semi-quantitative circadian IOP curve. There is noise in the system ‒ most notably blinks, which can raise IOP significantly and frequently albeit transiently. These investigators have developed an automated algorithm to detect the IOP peaks attributable to blinks that is highly accurate when compared to simultaneous video recordings of a subset of subjects. The immediate application of this algorithm is the ability to clean up the CLS output by filtering out the blinks and better illustrating the background IOP variability that occurs during CLS wear. Other potential applications include determination of blink rate in disease states in which blink rate is known to be relevant, as in some neurological or psychiatric conditions. One caveat with this latter use is that the device itself resides on the cornea and has a modest discomfort factor that may induce blink rates different from unperturbed resting blink rates. There remain many unanswered questions regarding the clinical significance of circadian IOP variation and the emergence of tools such as the Triggerfish CLS will afford us the opportunity to address these going forward. The authors are to be commended on taking the next step toward a better signalto- noise ratio with this device.

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