Identifying Biomarkers Using a Portable, Home-Based Eye-Tracking System to Predict Short-Term Visual Fatigue Deterioration: Prospective Observational Feasibility Study.

backgroundThe escalating prevalence of screen-related eye fatigue has become a health burden in the digital era worldwide, yet routine monitoring relies largely on subjective reports. This underscores the urgent need for clinically applicable, objective diagnostic solutions. Ocular metrics provide an objective method to assess computer vision syndrome, or asthenopia.

objectiveThis study aimed to develop and evaluate an integrated at-home system for predicting short-term deteriorated asthenopia using objective ocular metrics. This system classifies the short-term risk level for practical monitoring and automatically generates a session report that summarizes metrics to complement symptom-based evaluation.

methodsWe developed EyeFatigue Tracker, an integrated at-home system delivered via a desktop app, comprising a head-mounted device to record binocular infrared eye videos, a deep learning (DL) model to extract ocular metrics, and a machine learning (ML) classifier to estimate asthenopia risk. The DL model, trained on an in-house dataset, segments the palpebral fissure, pupil, and iris from recorded videos to derive ocular metrics. To build the prediction model, participants were recruited to complete a 1-hour computer gameplay session. Changes in the Computer Vision Syndrome Questionnaire (CVS-Q) scores served as the primary outcome measure to classify participants into deteriorated and nondeteriorated asthenopia groups. Metrics showing significant between-group differences were used as inputs for four ML models, including support vector machine (SVM), decision tree, extreme gradient boosting (XGBoost), and random forest, to identify deteriorated asthenopia. Model performance was evaluated with fivefold cross-validation.

resultsThis study enrolled 38 participants aged 19-31 (mean 24.8, SD 3.11) years. Following visual tasks, participants' CVS-Q scores were higher compared to baseline values (mean 9.21, SD 4.57, vs mean 6.76, SD 3.76; P<.001). Alongside the critical flicker fusion frequency (CFF), nine key features were selected as predictive indicators, with the top five reflecting fissure length variability (variance, coefficient of variation, and SD), average blink duration, and pupil size variability (coefficient of variation). Most ML models exhibited high discriminative ability, with the random forest achieving the best overall performance (mean accuracy 0.720, SD 0.035; mean area under the receiver operating characteristic curve 0.850, 95% CI 0.830-0.860).

conclusionsThe findings highlight the potential of objective indicators in identifying individuals at risk for asthenopia following computer gameplay. The ML models using ocular biomarkers identified in this study achieved plausible discriminative ability in detecting deteriorated asthenopia. EyeFatigue Tracker functions as an integrated, at-home system that produces a risk level prediction and a concise session report, supporting early detection and informing preventive care in real-world settings.