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Blink rate measured in situ decreases while reading from printed text or digital devices, regardless of task duration, complexity or working distance | medRxiv
<!DOCTYPE html> <html lang="en" dir="ltr" xmlns="http://www.w3.org/1999/xhtml" xmlns:mml="http://www.w3.org/1998/Math/MathML"> <head prefix="og: http://ogp.me/ns# article: http://ogp.me/ns/article# book: http://ogp.me/ns/book#" > <!--[if IE]><![endif]--> <link rel="dns-prefetch" href="//d33xdlntwy0kbs.cloudfront.net" /> <link rel="dns-prefetch" href="//cdn.jsdelivr.net" /> <link rel="dns-prefetch" href="//www.google.com" /> <link rel="dns-prefetch" href="//scholar.google.com" /> <link rel="dns-prefetch" href="//www.googletagmanager.com" /> <link rel="dns-prefetch" href="//rum-static.pingdom.net" /> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <link rel="shortcut icon" href="https://www.medrxiv.org/sites/default/files/images/favicon.ico" type="image/vnd.microsoft.icon" /> <meta name="viewport" content="width=device-width, initial-scale=1" /> <meta name="type" content="article" /> <meta name="category" content="article" /> <meta name="HW.identifier" content="/medrxiv/early/2022/11/22/2022.11.19.22282503.atom" /> <meta name="HW.pisa" content="medrxiv;2022.11.19.22282503v1" /> <meta name="DC.Format" content="text/html" /> <meta name="DC.Language" content="en" /> <meta name="DC.Title" content="Blink rate measured in situ decreases while reading from printed text or digital devices, regardless of task duration, complexity or working distance" /> <meta name="DC.Identifier" content="10.1101/2022.11.19.22282503" /> <meta name="DC.Date" content="2022-11-22" /> <meta name="DC.Publisher" content="Cold Spring Harbor Laboratory Press" /> <meta name="DC.Rights" content="© 2022, Posted by Cold Spring Harbor Laboratory. The copyright holder for this pre-print is the author. All rights reserved. The material may not be redistributed, re-used or adapted without the author's permission." /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Description" content="Purpose To compare blinking measured in situ during various tasks and examine relationships with ocular surface symptoms. Day-to-day repeatability of blink rate and interblink interval was assessed. Methods Twenty-four students (28.6±6.3 years; 8M:16F) completed six reading tasks (printed text, laptop, TV, smartphone, smartphone at 50% brightness, smartphone with complex text), and two non-reading tasks (conversation, walking) in a randomised cross-over study. Ocular surface symptoms and clinical signs were assessed. Blink rate and interblink interval were measured using a wearable eye tracking headset. Blink parameters were compared across tasks and time (linear mixed model and post hoc comparisons with Bonferroni correction). Associations between blinking, symptoms, ocular surface, and clinical signs were assessed (Spearman’s correlation). The smartphone reading task was completed twice to determine coefficient of repeatability. Results Blink rate was lower (mean 10.7±9.7 blinks/min) and interblink interval longer (mean 9.6±8.7s) during all reading tasks compared to conversation (mean 32.4±12.4 blinks/min; 1.5±0.6s) and walking (mean 31.3±15.5 blinks/min; 1.9±1.3s) (p<0.001). There were no significant differences in blink parameters between any of the reading tasks, nor between conversation and walking. Changes in blinking occurred within one minute of starting the task. No associations were evident between blink rate or interblink interval and ocular surface symptoms or signs. Coefficient of repeatability was ±12.4 blinks/min for blink rate and ±18.8s for interblink interval. Conclusion Spontaneous blinking can be reliably measured in situ . Blink rate was reduced and interblink interval increased during reading compared to conversation and walking. Changes in blinking were immediate and sustained, and not associated with ocular surface symptoms or signs. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research did not receive specific funding from agencies in the public, commercial, or not-for-profit sectors. The first author, NC received a UNSW Tuition Fee Remission Postgraduate Research Scholarship and the Australian Government Research Training Program Thesis Completion Scholarship. The research was also supported by the Dorothy Carlborg Research Grant from the Cornea and Contact Lens Society of Australia, and the UNSW Faculty of Science Research Infrastructure Scheme. The funding sources have no involvement in the study design, conduct of the research, collection, analysis and interpretation of data, writing of the report, preparation of the article or in the decision to submit the article for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval was obtained from the UNSW Sydney Human Research Ethics Advisory Panel I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets generated during and/or analysed during the current study are available in the Mendeley Data repository <https://data.mendeley.com/drafts/j63x6bxj8k>" /> <meta name="DC.Contributor" content="Ngozi Charity Chidi-Egboka" /> <meta name="DC.Contributor" content="Isabelle Jalbert" /> <meta name="DC.Contributor" content="Jiaying Chen" /> <meta name="DC.Contributor" content="Nancy E. Briggs" /> <meta name="DC.Contributor" content="Blanka Golebiowski" /> <meta name="article:published_time" content="2022-11-22" /> <meta name="citation_title" content="Blink rate measured in situ decreases while reading from printed text or digital devices, regardless of task duration, complexity or working distance" /> <meta name="citation_abstract" lang="en" content="<h3>Abstract</h3> <h3>Purpose</h3> <p>To compare blinking measured <i>in situ</i> during various tasks and examine relationships with ocular surface symptoms. Day-to-day repeatability of blink rate and interblink interval was assessed.</p><h3>Methods</h3> <p>Twenty-four students (28.6±6.3 years; 8M:16F) completed six reading tasks (printed text, laptop, TV, smartphone, smartphone at 50% brightness, smartphone with complex text), and two non-reading tasks (conversation, walking) in a randomised cross-over study. Ocular surface symptoms and clinical signs were assessed. Blink rate and interblink interval were measured using a wearable eye tracking headset. Blink parameters were compared across tasks and time (linear mixed model and post hoc comparisons with Bonferroni correction). Associations between blinking, symptoms, ocular surface, and clinical signs were assessed (Spearman’s correlation). The smartphone reading task was completed twice to determine coefficient of repeatability.</p><h3>Results</h3> <p>Blink rate was lower (mean 10.7±9.7 blinks/min) and interblink interval longer (mean 9.6±8.7s) during all reading tasks compared to conversation (mean 32.4±12.4 blinks/min; 1.5±0.6s) and walking (mean 31.3±15.5 blinks/min; 1.9±1.3s) (p&lt;0.001). There were no significant differences in blink parameters between any of the reading tasks, nor between conversation and walking. Changes in blinking occurred within one minute of starting the task. No associations were evident between blink rate or interblink interval and ocular surface symptoms or signs. Coefficient of repeatability was ±12.4 blinks/min for blink rate and ±18.8s for interblink interval.</p><h3>Conclusion</h3> <p>Spontaneous blinking can be reliably measured <i>in situ</i>. Blink rate was reduced and interblink interval increased during reading compared to conversation and walking. Changes in blinking were immediate and sustained, and not associated with ocular surface symptoms or signs.</p>" /> <meta name="citation_journal_title" content="medRxiv" /> <meta name="citation_publisher" content="Cold Spring Harbor Laboratory Press" /> <meta name="citation_publication_date" content="2022/01/01" /> <meta name="citation_mjid" content="medrxiv;2022.11.19.22282503v1" /> <meta name="citation_id" content="2022.11.19.22282503v1" /> <meta name="citation_public_url" content="https://www.medrxiv.org/content/10.1101/2022.11.19.22282503v1" /> <meta name="citation_abstract_html_url" content="https://www.medrxiv.org/content/10.1101/2022.11.19.22282503v1.abstract" /> <meta name="citation_full_html_url" content="https://www.medrxiv.org/content/10.1101/2022.11.19.22282503v1.full" /> <meta name="citation_pdf_url" content="https://www.medrxiv.org/content/medrxiv/early/2022/11/22/2022.11.19.22282503.full.pdf" /> <meta name="citation_doi" content="10.1101/2022.11.19.22282503" /> <meta name="citation_num_pages" content="32" /> <meta name="citation_article_type" content="Article" /> <meta name="citation_firstpage" content="2022.11.19.22282503" /> <meta name="citation_author" content="Ngozi Charity Chidi-Egboka" /> <meta name="citation_author_institution" content="School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney" /> <meta name="citation_author_email" content="n.chidi-egboka@unsw.edu.au" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-7941-7233" /> <meta name="citation_author" content="Isabelle Jalbert" /> <meta name="citation_author_institution" content="School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-1351-0072" /> <meta name="citation_author" content="Jiaying Chen" /> <meta name="citation_author_institution" content="School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney" /> <meta name="citation_author" content="Nancy E. Briggs" /> <meta name="citation_author_institution" content="School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney" /> <meta name="citation_author_institution" content="Mark Wainwright Analytical Centre, UNSW Sydney" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-1134-0807" /> <meta name="citation_author" content="Blanka Golebiowski" /> <meta name="citation_author_institution" content="School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-9348-6470" /> <meta name="citation_reference" content="Evinger C, Bao JB, Powers AS, Kassem IS, Schicatano EJ, Henriquez VM, et al. Dry eye, blinking, and blepharospasm. Mov Disord. 2002;17 Suppl 2:S75–8." /> <meta name="citation_reference" content="Nakamori K, Odawara M, Nakajima T, Mizutani T, Tsubota K. Blinking is controlled primarily by ocular surface conditions. Am J Ophthalmol. 1997;124:24–30." /> <meta name="citation_reference" content="Dumery B, Van Toi V. Relationship between blink rate, ocular discomfort, and visual tasks. Invest Ophthalmol Vis Sci. 1997;38:326." /> <meta name="citation_reference" content="Doughty MJ. Consideration of Three Types of Spontaneous Eyeblink Activity in Normal Humans: during Reading and Video Display Terminal Use, in Primary Gaze, and while in Conversation. Optom Vis Sci. 2001;78:712–25." /> <meta name="citation_reference" content="Jaiswal S, Asper L, Long J, Lee A, Harrison K, Golebiowski B. Ocular and visual discomfort associated with smartphones, tablets and computers: what we do and do not know. Clin Exp Optom. 2019;102:463–77." /> <meta name="citation_reference" content="Stern JA, Boyer D, Schroeder D. Blink Rate: A Possible Measure of Fatigue. Hum Factors. 1994;36:285–97." /> <meta name="citation_reference" content="Cardona G, García C, Serés C, Vilaseca M, Gispets J. Blink Rate, Blink Amplitude, and Tear Film Integrity during Dynamic Visual Display Terminal Tasks. Curr Eye Res. 2011;36:190–7." /> <meta name="citation_reference" content="Rosenfield M, Jahan S, Nunez K, Chan K. Cognitive demand, digital screens and blink rate. Comput Human Behav. 2015;51:403–6." /> <meta name="citation_reference" content="Argilés M, Cardona G, Pérez-Cabré E, Rodríguez M. Blink rate and incomplete blinks in six different controlled hard-copy and electronic reading conditions. Invest Ophthalmol Vis Sci. 2015;56:6679–85." /> <meta name="citation_reference" content="Tanaka Y, Yamaoka K. Blink Activity and Task Difficulty. Percept Mot Skills. 1993;77:55–66." /> <meta name="citation_reference" content="Chu CA, Rosenfield M, Portello JK. Blink patterns: Reading from a computer screen versus hard copy. Optom Vis Sci. 2014;91:297–302." /> <meta name="citation_reference" content="Bentivoglio AR, Bressman SB, Cassetta E, Carretta D, Tonali P, Albanese A. Analysis of blink rate patterns in normal subjects. Mov Disord. 1997;12:1028–34." /> <meta name="citation_reference" content="Tsubota K, Nakamori K. Dry Eyes and Video Display Terminals. N Engl J Med. 1993;328:584." /> <meta name="citation_reference" content="Himebaugh NL, Begley CG, Bradley A, Wilkinson JA. Blinking and tear break-up during four visual tasks. Optom Vis Sci. 2009;86:E106–E14." /> <meta name="citation_reference" content="Doughty MJ. Further Assessment of Gender- and Blink Pattern-Related Differences in the Spontaneous Eyeblink Activity in Primary Gaze in Young Adult Humans. Optom Vis Sci. 2002;79:439–47." /> <meta name="citation_reference" content="Cardona G, Quevedo N. Blinking and driving: the influence of saccades and cognitive workload. Curr Eye Res. 2014;39:239–44." /> <meta name="citation_reference" content="Wu Z, Begley CG, Situ P, Simpson T, Liu H. The Effects of Mild Ocular Surface Stimulation and Concentration on Spontaneous Blink Parameters. Curr Eye Res. 2014;39:9–20." /> <meta name="citation_reference" content="Borges FP, Garcia DM. Distribution of spontaneous inter-blink interval in repeated measurements with and without topical ocular anesthesia. Arq Bras Oftalmol. 2010;73:329–32." /> <meta name="citation_reference" content="Chen J, Chidi-Egboka NC, Jalbert I, Golebiowski B. Is there a consistent way to measure spontaneous blinking? - A narrative review. 2022;invited review conditionally accepted." /> <meta name="citation_reference" content="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;40:519–28." /> <meta name="citation_reference" content="Doughty MJ. Spontaneous eyeblink activity under different conditions of gaze (eye position) and visual glare. Graefes Arch Clin Exp Ophthalmol. 2014;252:1147–53." /> <meta name="citation_reference" content="Portello JK, Rosenfield M, Chu CA. Blink rate, incomplete blinks and computer vision syndrome. Optom Vis Sci. 2013;90:482–7." /> <meta name="citation_reference" content="Tsubota K, Hata S, Okusawa Y, Egami F, Ohtsuki T, Nakamori K. Quantitative videographic analysis of blinking in normal subjects and patients with dry eye. Arch Ophthalmol. 1996;114:715–20." /> <meta name="citation_reference" content="Muntz A, Turnbull PR, Kim AD, Gokul A, Wong D, Tsay TS-W, et al. Extended screen time and dry eye in youth. Cont Lens Anterior Eye. 2021:101541." /> <meta name="citation_reference" content="Chen S, Epps J. Efficient and robust pupil size and blink estimation from near-field video sequences for human–machine interaction. IEEE transactions on cybernetics. 2014;44:2356–67." /> <meta name="citation_reference" content="Chidi-Egboka NC, Jalbert I, Wagner P, Golebiowski B. Blinking and normal ocular surface in school-aged children, and the effects of age and screen time. Br J Ophthalmol. 2022;doi: 10.1136/bjophthalmol-2022-321645." /> <meta name="citation_reference" content="Chidi-Egboka NC, Jalbert I, Golebiowski B. Smartphone gaming induces dry eye symptoms and reduces blinking in school-aged children. Eye 2022;DOI 10.1038/s41433-022-02122-2." /> <meta name="citation_reference" content="Hidalgo-Lopez E, Zimmermann G, Pletzer B. Intra-subject consistency of spontaneous eye blink rate in young women across the menstrual cycle. Sci Rep. 2020;10:1–8." /> <meta name="citation_reference" content="Yong PT, Arif N, Sharanjeet-Kaur S, Hairol MI. Double Eyelid Tape Wear Affects Anterior Ocular Health among Young Adult Women with Single Eyelids. Int J Environ Res Public Health. 2020;17:7701." /> <meta name="citation_reference" content="Doughty MJ. Effects of background lighting and retinal illuminance on spontaneous eyeblink activity of human subjects in primary eye gaze. Eye & contact lens. 2013;39:138–46." /> <meta name="citation_reference" content="Doughty MJ. Influence of mouth and jaw movements on dynamics of spontaneous eye blink activity assessed during slitlamp biomicroscopy. Clin Exp Optom. 2018;101:345–53." /> <meta name="citation_reference" content="Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135–60." /> <meta name="citation_reference" content="Scheiman M, Wick B. Clinical management of binocular vision : heterophoric, accommodative, and eye movement disorders. 3. Aufl. ed: Philadelphia, Pa. : Lippincott.; 2008." /> <meta name="citation_reference" content="Gowrisankaran S, Nahar NK, Hayes JR, Sheedy JE. Asthenopia and Blink Rate Under Visual and Cognitive Loads. Optom Vis Sci. 2012;89:97–104." /> <meta name="citation_reference" content="Rodriguez JD, Lane KJ, Ousler GW, 3rd, Angjeli E, Smith LM, Abelson MB. Blink: Characteristics, Controls, and Relation to Dry Eyes. Curr Eye Res. 2018;43:52–66." /> <meta name="citation_reference" content="Tucker KA. Ten tiny breaths. [Stouffville, Ont.]: Papoti Books; 2012." /> <meta name="citation_reference" content="Good Calculators. Flesch Kincaid Calculator. https://goodcalculators.com/flesch-kincaid-calculator/ Accessed 12 September 2019. 2019." /> <meta name="citation_reference" content="The Legacy of David Foster Wallace: University of Iowa Press; 2012." /> <meta name="citation_reference" content="Gill K, Mao A, Powell AM, Sheidow T. Digital reader vs print media: the role of digital technology in reading accuracy in age-related macular degeneration. Eye. 2013;27:639–43." /> <meta name="citation_reference" content="Sanchez CA, Goolsbee JZ. Character size and reading to remember from small displays. Computers & Education. 2010;55:1056–62." /> <meta name="citation_reference" content="Jasper. 100 Awesome Conversation Starters - Be The Fun Guy At Every Party. https://www.mantelligence.com/conversation-starters/ Accessed 12 September 2019. 2017." /> <meta name="citation_reference" content="Boga A, Stapleton F, Briggs N, Golebiowski B. Daily fluctuations in ocular surface symptoms during the normal menstrual cycle and with the use of oral contraceptives. Ocul Surf. 2019;17:763–70." /> <meta name="citation_reference" content="Chalmers RL, Begley CG, Caffery B. Validation of the 5-Item Dry Eye Questionnaire (DEQ-5): Discrimination across self-assessed severity and aqueous tear deficient dry eye diagnoses. Cont Lens Anterior Eye. 2010;33:55–60." /> <meta name="citation_reference" content="Schaumberg DA, Gulati A, Mathers WD, Clinch T, Lemp MA, Nelson JD, et al. Development and Validation of a Short Global Dry Eye Symptom Index. Ocul Surf. 2007;5:50–7." /> <meta name="citation_reference" content="Schiffman RM, Christianson M, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the ocular surface disease index. Arch Ophthalmol. 2000;118:615–21." /> <meta name="citation_reference" content="Eom Y, Lee J-S, Kang S-Y, Kim HM, Song J-S. Correlation Between Quantitative Measurements of Tear Film Lipid Layer Thickness and Meibomian Gland Loss in Patients With Obstructive Meibomian Gland Dysfunction and Normal Controls. Am J Ophthalmol. 2013;155:1104-10.e2." /> <meta name="citation_reference" content="Baek J, Doh SH, Chung SK. Comparison of Tear Meniscus Height Measurements Obtained With the Keratograph and Fourier Domain Optical Coherence Tomography in Dry Eye. Cornea. 2015;34:1209–13." /> <meta name="citation_reference" content="Hong J, Sun X, Wei A, Cui X, Li Y, Qian T, et al. Assessment of tear film stability in dry eye with a newly developed keratograph. Cornea. 2013;32:716–21." /> <meta name="citation_reference" content="Bron AJ, Abelson MB, Ousler G, Pearce E, Tomlinson A, Yokoi N, et al. Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007). Ocular Surface. 2007;5:108–52." /> <meta name="citation_reference" content="Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, et al. TFOS DEWS II Diagnostic Methodology report. Ocul Surf. 2017;15:539–74." /> <meta name="citation_reference" content="Nichols JJ, Nichols KK, Puent B, Saracino M, Mitchell GL. Evaluation of tear film interference patterns and measures of tear break-up time. Optom Vis Sci. 2002;79:363–9." /> <meta name="citation_reference" content="Bron AJ, Evans VE, Smith JA. Grading Of Corneal and Conjunctival Staining in the Context of Other Dry Eye Tests. Cornea. 2003;22:640–50." /> <meta name="citation_reference" content="Delaveris A, Stahl U, Madigan M, Jalbert I. Comparative performance of lissamine green stains. Cont Lens Anterior Eye. 2018;41:23–7." /> <meta name="citation_reference" content="Foulks GN, Bron AJ. Meibomian gland dysfunction: a clinical scheme for description, diagnosis, classification, and grading. Ocul Surf. 2003;1:107–26." /> <meta name="citation_reference" content="Pult H, Riede-Pult B. Comparison of subjective grading and objective assessment in meibography. Cont Lens Anterior Eye. 2013;36:22–7." /> <meta name="citation_reference" content="Tomlinson A, Bron AJ, Korb DR, Amano S, Paugh JR, Ian Pearce E, et al. The international workshop on meibomian gland dysfunction: Report of the diagnosis subcommittee. Invest Ophthalmol Vis Sci. 2011;52:2006–49." /> <meta name="citation_reference" content="Kim JS, Wang MTM, Craig JP. Exploring the Asian ethnic predisposition to dry eye disease in a pediatric population. Ocul Surf. 2019;17:70–7." /> <meta name="citation_reference" content="PupilLabs. Pupil Docs - Master. https://docs.pupil-labs.com/core/software/pupil-capture/#blink-detection Accessed 20 August 2021." /> <meta name="citation_reference" content="Zaman ML, Doughty MJ. Some methodological issues in the assessment of the spontaneous eyeblink frequency in man. Ophthalmic Physiol Opt. 1997;17:421–32." /> <meta name="citation_reference" content="Barbato G, Ficca G, Muscettola G, Fichele M, Beatrice M, Rinaldi F. Diurnal variation in spontaneous eye-blink rate. Psychiatry Res. 2000;93:145–51." /> <meta name="citation_reference" content="Patel P, Henderson R, Bradley L, Galloway B, Hunter L. Effect of visual display unit use on blink rate and tear stability. Optom Vis Sci. 1991;68:888–92." /> <meta name="citation_reference" content="Freudenthaler N, Neuf H, Kadner G, Schlote T. Characteristics of spontaneous eyeblink activity during video display terminal use in healthy volunteers. Graefes Arch Clin Exp Ophthalmol. 2003;241:914–20." /> <meta name="citation_reference" content="Talens-Estarelles C, García-Marqués JV, Cervino A, García-Lázaro S. Use of digital displays and ocular surface alterations: A review. Ocul Surf. 2021;19:252–65." /> <meta name="citation_reference" content="Stern JA, Walrath LC, Goldstein R. The endogenous eyeblink. Psychophysiology. 1984;21:22–33." /> <meta name="citation_reference" content="Cho P, Sheng C, Chan C, Lee R, Tam J. Baseline blink rates and the effect of visual task difficulty and position of gaze. Curr Eye Res. 2000;20:64–70." /> <meta name="citation_reference" content="Mantelli F, Tiberi E, Micera A, Lambiase A, Visintini F, Bonini S. MUC5AC overexpression in tear film of neonates. Graefes Arch Clin Exp Ophthalmol. 2007;245:1377–81." /> <meta name="citation_reference" content="Zaman M, Doughty M, Button N. The exposed ocular surface and its relationship to spontaneous eyeblink rate in elderly caucasians. Exp Eye Res. 1998;67:681–6." /> <meta name="citation_reference" content="Ranti C, Jones W, Klin A, Shultz S. Blink Rate patterns provide a Reliable Measure of individual engagement with Scene content. Sci Rep. 2020;10:1–10." /> <meta name="citation_reference" content="Jansen ME, Begley CG, Himebaugh NH, Port NL. Effect of Contact Lens Wear and a Near Task on Tear Film Break-Up. Optom Vis Sci. 2010;87." /> <meta name="citation_reference" content="Fu HH, White KA, Collings RDJPCJoPR. The Effects of Conversation Arousal Level on Attention Processes. 2020;25." /> <meta name="citation_reference" content="Chu C, Rosenfield M, Portello J. Computer vision syndrome: blink rate and dry eye during hard copy or computer viewing. Investig Opthalmology Vis Sci. 2010;51:951." /> <meta name="citation_reference" content="Hue JE, Rosenfield M, Saá G. Reading from electronic devices versus hardcopy text. Work. 2014;47:303–7." /> <meta name="citation_reference" content="Benedetto S, Carbone A, Drai-Zerbib V, Pedrotti M, Baccino T. Effects of luminance and illuminance on visual fatigue and arousal during digital reading. Comput Human Behav. 2014;41:112–9." /> <meta name="citation_reference" content="citation_title=Vision Models for High Dynamic Range and Wide Colour Gamut Imaging;citation_pages=65-93;citation_year=2020" /> <meta name="citation_reference" content="Tsubota K, Nakamori K. Effects of Ocular Surface Area and Blink Rate on Tear Dynamics. Arch Ophthalmol. 1995;113:155–8." /> <meta name="citation_reference" content="Park JS, Choi MJ, Ma JE, Moon JH, Moon HJ. Influence of Cellular Phone Videos and Games on Dry Eye Syndrome in University Students. J Korean Acad Community Health Nurs. 2014;25:12–23." /> <meta name="citation_reference" content="Golebiowski B, Long J, Harrison K, Lee A, Chidi-Egboka N, Asper L. Smartphone Use and Effects on Tear Film, Blinking and Binocular Vision. Curr Eye Res. 2020;45:428–34." /> <meta name="citation_reference" content="Rosenfield M. Computer vision syndrome: a review of ocular causes and potential treatments. Ophthalmic Physiol Opt. 2011;31:502–15." /> <meta name="citation_reference" content="Braun RJ, King-Smith PE, Begley CG, Li L, Gewecke NR. Dynamics and function of the tear film in relation to the blink cycle. Prog Retin Eye Res. 2015;45:132–64." /> <meta name="citation_reference" content="Pult H, Riede-Pult BH, Murphy PJ. The Relation Between Blinking and Conjunctival Folds and Dry Eye Symptoms. Optom Vis Sci. 2013;90." /> <meta name="citation_reference" content="Pult H, Murphy P, Riede-Pult B. Velocity of upper lid spontaneous complete blinks and dry eye. Cont Lens Anterior Eye. 2015;38:e10–e1." /> <meta name="citation_reference" content="Soleimanloo SS, Wilkinson VE, Cori JM, Westlake J, Stevens B, Downey LA, et al. Eye-Blink Parameters Detect On-Road Track-Driving Impairment Following Severe Sleep Deprivation. 2019;15:1271–84." /> <meta name="twitter:title" content="Blink rate measured in situ decreases while reading from printed text or digital devices, regardless of task duration, complexity or working distance" /> <meta name="twitter:site" content="@medrxivpreprint" /> <meta name="twitter:card" content="summary" /> <meta name="twitter:image" content="https://www.medrxiv.org/sites/default/files/images/medrxiv_logo_homepage7-5-small-test-up.png" /> <meta name="twitter:description" content="Purpose To compare blinking measured in situ during various tasks and examine relationships with ocular surface symptoms. Day-to-day repeatability of blink rate and interblink interval was assessed. Methods Twenty-four students (28.6±6.3 years; 8M:16F) completed six reading tasks (printed text, laptop, TV, smartphone, smartphone at 50% brightness, smartphone with complex text), and two non-reading tasks (conversation, walking) in a randomised cross-over study. Ocular surface symptoms and clinical signs were assessed. Blink rate and interblink interval were measured using a wearable eye tracking headset. Blink parameters were compared across tasks and time (linear mixed model and post hoc comparisons with Bonferroni correction). Associations between blinking, symptoms, ocular surface, and clinical signs were assessed (Spearman’s correlation). The smartphone reading task was completed twice to determine coefficient of repeatability. Results Blink rate was lower (mean 10.7±9.7 blinks/min) and interblink interval longer (mean 9.6±8.7s) during all reading tasks compared to conversation (mean 32.4±12.4 blinks/min; 1.5±0.6s) and walking (mean 31.3±15.5 blinks/min; 1.9±1.3s) (p<0.001). There were no significant differences in blink parameters between any of the reading tasks, nor between conversation and walking. Changes in blinking occurred within one minute of starting the task. No associations were evident between blink rate or interblink interval and ocular surface symptoms or signs. Coefficient of repeatability was ±12.4 blinks/min for blink rate and ±18.8s for interblink interval. Conclusion Spontaneous blinking can be reliably measured in situ . Blink rate was reduced and interblink interval increased during reading compared to conversation and walking. Changes in blinking were immediate and sustained, and not associated with ocular surface symptoms or signs. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research did not receive specific funding from agencies in the public, commercial, or not-for-profit sectors. The first author, NC received a UNSW Tuition Fee Remission Postgraduate Research Scholarship and the Australian Government Research Training Program Thesis Completion Scholarship. The research was also supported by the Dorothy Carlborg Research Grant from the Cornea and Contact Lens Society of Australia, and the UNSW Faculty of Science Research Infrastructure Scheme. The funding sources have no involvement in the study design, conduct of the research, collection, analysis and interpretation of data, writing of the report, preparation of the article or in the decision to submit the article for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval was obtained from the UNSW Sydney Human Research Ethics Advisory Panel I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets generated during and/or analysed during the current study are available in the Mendeley Data repository <https://data.mendeley.com/drafts/j63x6bxj8k>" /> <meta name="og-title" property="og:title" content="Blink rate measured in situ decreases while reading from printed text or digital devices, regardless of task duration, complexity or working distance" /> <meta name="og-url" property="og:url" content="https://www.medrxiv.org/content/10.1101/2022.11.19.22282503v1" /> <meta name="og-site-name" property="og:site_name" content="medRxiv" /> <meta name="og-description" property="og:description" content="Purpose To compare blinking measured in situ during various tasks and examine relationships with ocular surface symptoms. Day-to-day repeatability of blink rate and interblink interval was assessed. Methods Twenty-four students (28.6±6.3 years; 8M:16F) completed six reading tasks (printed text, laptop, TV, smartphone, smartphone at 50% brightness, smartphone with complex text), and two non-reading tasks (conversation, walking) in a randomised cross-over study. Ocular surface symptoms and clinical signs were assessed. Blink rate and interblink interval were measured using a wearable eye tracking headset. Blink parameters were compared across tasks and time (linear mixed model and post hoc comparisons with Bonferroni correction). Associations between blinking, symptoms, ocular surface, and clinical signs were assessed (Spearman’s correlation). The smartphone reading task was completed twice to determine coefficient of repeatability. Results Blink rate was lower (mean 10.7±9.7 blinks/min) and interblink interval longer (mean 9.6±8.7s) during all reading tasks compared to conversation (mean 32.4±12.4 blinks/min; 1.5±0.6s) and walking (mean 31.3±15.5 blinks/min; 1.9±1.3s) (p<0.001). There were no significant differences in blink parameters between any of the reading tasks, nor between conversation and walking. Changes in blinking occurred within one minute of starting the task. No associations were evident between blink rate or interblink interval and ocular surface symptoms or signs. Coefficient of repeatability was ±12.4 blinks/min for blink rate and ±18.8s for interblink interval. Conclusion Spontaneous blinking can be reliably measured in situ . Blink rate was reduced and interblink interval increased during reading compared to conversation and walking. Changes in blinking were immediate and sustained, and not associated with ocular surface symptoms or signs. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research did not receive specific funding from agencies in the public, commercial, or not-for-profit sectors. The first author, NC received a UNSW Tuition Fee Remission Postgraduate Research Scholarship and the Australian Government Research Training Program Thesis Completion Scholarship. The research was also supported by the Dorothy Carlborg Research Grant from the Cornea and Contact Lens Society of Australia, and the UNSW Faculty of Science Research Infrastructure Scheme. The funding sources have no involvement in the study design, conduct of the research, collection, analysis and interpretation of data, writing of the report, preparation of the article or in the decision to submit the article for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval was obtained from the UNSW Sydney Human Research Ethics Advisory Panel I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets generated during and/or analysed during the current study are available in the Mendeley Data repository <https://data.mendeley.com/drafts/j63x6bxj8k>" /> <meta name="og-type" property="og:type" content="article" /> <meta name="og-image" property="og:image" content="https://www.medrxiv.org/sites/default/files/images/medrxiv_logo_homepage7-5-small-test-up.png" /> <meta name="citation_date" content="2022-11-22" /> <link rel="alternate" type="text/plain" title="Full Text (Plain)" href="/content/10.1101/2022.11.19.22282503v1.full.txt" /> <link rel="alternate" type="application/vnd.ms-powerpoint" title="Powerpoint" href="/content/10.1101/2022.11.19.22282503v1.ppt" /> <link rel="alternate" type="application/pdf" title="Full Text (PDF)" href="/content/10.1101/2022.11.19.22282503v1.full.pdf" /> <meta name="description" content="medRxiv - The Preprint Server for Health Sciences" /> <meta name="generator" content="Drupal 7 (http://drupal.org)" /> <link rel="canonical" 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section-content"> <div id="zone-content" class="zone zone-content clearfix container-30"> <div class="grid-28 suffix-1 prefix-1 region region-content" id="region-content"> <div class="region-inner region-content-inner"> <a id="main-content"></a> <div class="block block-system block-main block-system-main odd block-without-title" id="block-system-main"> <div class="block-inner clearfix"> <div class="content clearfix"> <div class="panel-display panels-960-layout jcore-2col-layout" > <div class="panel-row-wrapper clearfix"> <div class="main-content-wrapper grid-17 suffix-1 alpha"> <div class="panel-panel panel-region-content"> <div class="inside"><div class="panel-pane pane-highwire-article-citation" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node585731" data-node-nid="585731" id="node-585731--2377252699" data-pisa="medrxiv;2022.11.19.22282503v1" data-pisa-master="medrxiv;2022.11.19.22282503" data-apath="/medrxiv/early/2022/11/22/2022.11.19.22282503.atom" data-hw-author-tooltip-instance=""><div class="highwire-cite highwire-cite-highwire-article highwire-citation-medrxiv-article-top clearfix has-author-tooltip" > <h1 class="highwire-cite-title" id="page-title">Blink rate measured <em>in situ</em> decreases while reading from printed text or digital devices, regardless of task duration, complexity or working distance</h1> <div class="highwire-cite-authors" ><span class="highwire-citation-authors"><span class="highwire-citation-author first hw-author-orcid-logo-wrapper" data-delta="0"><a href="http://orcid.org/0000-0002-7941-7233" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Ngozi Charity</span> <span class="nlm-surname">Chidi-Egboka</span></span>, <span class="highwire-citation-author hw-author-orcid-logo-wrapper" data-delta="1"><a href="http://orcid.org/0000-0002-1351-0072" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Isabelle</span> <span class="nlm-surname">Jalbert</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Jiaying</span> <span class="nlm-surname">Chen</span></span>, <span class="highwire-citation-author hw-author-orcid-logo-wrapper" data-delta="3"><a href="http://orcid.org/0000-0002-1134-0807" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Nancy E.</span> <span class="nlm-surname">Briggs</span></span>, <span class="highwire-citation-author hw-author-orcid-logo-wrapper" data-delta="4"><a href="http://orcid.org/0000-0002-9348-6470" target="_blank" class="hw-author-orcid-logo link-icon-only link-icon"><span class="hw-icon-orcid hw-icon-color-orcid"></span> <span class="title element-invisible">View ORCID Profile</span></a><span class="nlm-given-names">Blanka</span> <span class="nlm-surname">Golebiowski</span></span></span></div> <div class="highwire-cite-metadata" ><span class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">doi:</span> https://doi.org/10.1101/2022.11.19.22282503 </span></div> </div> <div id="hw-article-author-popups-node-585731--2377252699" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Ngozi Charity Chidi-Egboka </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney</span>, NSW 2052, <span class='nlm-country'>Australia</span></div>OD, MPH</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Ngozi%2BCharity%2BChidi-Egboka%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chidi-Egboka%20NC&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ANgozi%2BCharity%2BChidi-Egboka%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link"><a href="http://orcid.org/0000-0002-7941-7233" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Ngozi Charity Chidi-Egboka</a></li><li class="author-corresp-email-link last"><span>For correspondence: <a href="mailto:n.chidi-egboka@unsw.edu.au" class="" data-icon-position="" data-hide-link-title="0">n.chidi-egboka@unsw.edu.au</a></span></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Isabelle Jalbert </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney</span>, NSW 2052, <span class='nlm-country'>Australia</span></div>OD, MPH, PhD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Isabelle%2BJalbert%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author 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2052, <span class='nlm-country'>Australia</span></div>BSc, MOptom</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Jiaying%2BChen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chen%20J&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJiaying%2BChen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Nancy E. Briggs </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney</span>, NSW 2052, <span class='nlm-country'>Australia</span></div><div class='author-affiliation'><span class='nlm-sup'>2</span><span class='nlm-institution'>Mark Wainwright Analytical Centre, UNSW Sydney</span></div>PhD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Nancy%2BE.%2BBriggs%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Briggs%20NE&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ANancy%2BE.%2BBriggs%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1134-0807" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Nancy E. Briggs</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Blanka Golebiowski </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney</span>, NSW 2052, <span class='nlm-country'>Australia</span></div>BOptom, PhD</span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Blanka%2BGolebiowski%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Golebiowski%20B&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li 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/></div><div class="panels-ajax-tab-wrap-biorxiv_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2 class="">Abstract</h2><div id="sec-1" class="subsection"><p id="p-5"><strong>Purpose</strong> To compare blinking measured <em>in situ</em> during various tasks and examine relationships with ocular surface symptoms. Day-to-day repeatability of blink rate and interblink interval was assessed.</p></div><div id="sec-2" class="subsection"><p id="p-6"><strong>Methods</strong> Twenty-four students (28.6±6.3 years; 8M:16F) completed six reading tasks (printed text, laptop, TV, smartphone, smartphone at 50% brightness, smartphone with complex text), and two non-reading tasks (conversation, walking) in a randomised cross-over study. Ocular surface symptoms and clinical signs were assessed. Blink rate and interblink interval were measured using a wearable eye tracking headset. Blink parameters were compared across tasks and time (linear mixed model and post hoc comparisons with Bonferroni correction). Associations between blinking, symptoms, ocular surface, and clinical signs were assessed (Spearman’s correlation). The smartphone reading task was completed twice to determine coefficient of repeatability.</p></div><div id="sec-3" class="subsection"><p id="p-7"><strong>Results</strong> Blink rate was lower (mean 10.7±9.7 blinks/min) and interblink interval longer (mean 9.6±8.7s) during all reading tasks compared to conversation (mean 32.4±12.4 blinks/min; 1.5±0.6s) and walking (mean 31.3±15.5 blinks/min; 1.9±1.3s) (p<0.001). There were no significant differences in blink parameters between any of the reading tasks, nor between conversation and walking. Changes in blinking occurred within one minute of starting the task. No associations were evident between blink rate or interblink interval and ocular surface symptoms or signs. Coefficient of repeatability was ±12.4 blinks/min for blink rate and ±18.8s for interblink interval.</p></div><div id="sec-4" class="subsection"><p id="p-8"><strong>Conclusion</strong> Spontaneous blinking can be reliably measured <em>in situ</em>. Blink rate was reduced and interblink interval increased during reading compared to conversation and walking. Changes in blinking were immediate and sustained, and not associated with ocular surface symptoms or signs.</p></div></div><h3>Competing Interest Statement</h3><p id="p-9">The authors have declared no competing interest.</p><h3>Funding Statement</h3><p id="p-10">This research did not receive specific funding from agencies in the public, commercial, or not-for-profit sectors. The first author, NC received a UNSW Tuition Fee Remission Postgraduate Research Scholarship and the Australian Government Research Training Program Thesis Completion Scholarship. The research was also supported by the Dorothy Carlborg Research Grant from the Cornea and Contact Lens Society of Australia, and the UNSW Faculty of Science Research Infrastructure Scheme. The funding sources have no involvement in the study design, conduct of the research, collection, analysis and interpretation of data, writing of the report, preparation of the article or in the decision to submit the article for publication. </p><h3>Author Declarations</h3><p id="p-11">I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.</p><p id="p-12">Yes</p><p id="p-13">The details of the IRB/oversight body that provided approval or exemption for the research described are given below:</p><p id="p-14">Approval was obtained from the UNSW Sydney Human Research Ethics Advisory Panel</p><p id="p-15">I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.</p><p id="p-16">Yes</p><p id="p-17">I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).</p><p id="p-18">Yes</p><p id="p-19">I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.</p><p id="p-20">Yes</p><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-others" id="fn-1"><p id="p-1"><strong>Commercial relationship disclosures 1.</strong> Ngozi Charity Chidi-Egboka, None declared; <strong>2.</strong> Isabelle Jalbert, None declared; <strong>3.</strong> Jiaying Chen, None declared; <strong>4.</strong> Nancy E. Briggs, None declared; <strong>5.</strong> Blanka Golebiowski, None declared</p></li><li class="fn-supported-by" id="fn-2"><p id="p-2"><strong>Funding</strong> This research did not receive specific funding from agencies in the public, commercial, or not-for-profit sectors.</p><p id="p-3">The first author, NC received a UNSW Tuition Fee Remission Postgraduate Research Scholarship and the Australian Government Research Training Program Thesis Completion Scholarship. The research was also supported by the Dorothy Carlborg Research Grant from the Cornea and Contact Lens Society of Australia, and the UNSW Faculty of Science Research Infrastructure Scheme. The funding sources have no involvement in the study design, conduct of the research, collection, analysis and interpretation of data, writing of the report, preparation of the article or in the decision to submit the article for publication.</p></li></ul></div><div class="section data-availability" id="sec-21"><h2 class="">Data Availability</h2><p id="p-73">The datasets generated during and/or analysed during the current study are available in the Mendeley Data repository</p><p id="p-74"> <a href="https://data.mendeley.com/drafts/j63x6bxj8k">https://data.mendeley.com/drafts/j63x6bxj8k</a> </p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-biorxiv-copyright" > <div class="pane-content"> <div class="field field-name-field-highwire-copyright field-type-text field-label-inline clearfix"><div class="field-label">Copyright </div><div class="field-items"><div class="field-item even">The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.<span class="license-type-none"> All rights reserved. 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