Detecting brain disease and injury affordably and in blink of an eye

Decorative illustrations of human eyes

MUSC and technology company blinkcns blend university and startup advantages to accelerate research

by Shawn Oberrath

Neurological diseases like Parkinson’s disease and Alzheimer’s disease, injuries like concussions and trauma, and conditions like dry eye syndrome and migraine headaches can all affect the brainstem and thus can change the blink reflex.

Changes in the blink reflex are measured in milliseconds. Blink, and you will definitely miss them, but technology company blinkcns’s EyeStat device will not.

In a 30-second test that delivers gentle puffs of air to the eyelid to stimulate blinking, high-speed cameras record 18,000 frames of data that measure 15 characteristics of the blink reflex – things like the time it takes from the air puff to the first eye movement, how long it takes the eyelid to close, and the total blink time – numbers that can’t be measured by the human eye alone.

An algorithm developed by the company takes the data and looks for “fingerprints” or patterns that indicate traumatic brain injury (TBI), Parkinson’s disease, or ADHD, and more ways to use the device are in the works.

The blink reflex is a very simple pathway composed of two cranial nerves. One, the trigeminal nerve, sends signals to the brainstem when it is stimulated. The other, the facial nerve, sends a signal back from the brainstem that closes the eye, resulting in a blink.

Damage to the brainstem from injury or disease influences the reflexive loop in ways that can be measured by the EyeStat technology, which has evolved to the point where it will become affordable for widespread use later this year.

EyeStat was first developed and tested at MUSC and later at startup blinkcns (formerly known as blinktbi) in conjunction with MUSC’s Zucker Institute for Innovation Commercialization (ZI), a leadership organization dedicated to shepherding the commercialization of innovations and intellectual assets created at MUSC.

blinkcns CEO Ryan Fiorini, Ph.D., explained the importance of the relationship. “EyeStat was invented at MUSC, and we were lucky to have a great principal investigator for all of our initial trials,” he said. “Small companies are great at taking new technologies and growing them from something academic into something that people will buy. But you also need the university because they can attract funding and have the infrastructure to run studies.”

Jesse Goodwin, MUSC’s Chief Innovation Officer, sees the importance of that relationship and makes it a priority for the university to stay involved with companies as they grow. “These connections are symbiotic,” she said. “Success requires close working ties between scientist inventors and companies with a strong business acumen and mindset, and it’s a win-win when things work out. MUSC’s lucky to have a group like ZI that stewards these relationships.”

Early prototypes of the device were large, expensive, and used mostly for research by institutions running sports teams. But the company and engineers at MUSC have continued to refine the technology and will release a new version this year.

With the newest version, a smartphone slides into a handheld device. An app on the phone runs the camera to capture and process images in response to air puffs created with inexpensive food-grade CO2 cartridges – the kind used to make home-brewed beer. This solution elegantly uses existing technologies and will bring the unit cost down to about $100. Fiorini envisions that this will finally allow any clinic, school or other facility to use EyeStat for screening or send one home with patients for self-monitoring.

Smartphone slid into blink reflex detection device, as seen from the front on mannequin head 
With the latest EyeStat device, the user slides a phone into the unit, which integrates with a CO2 cartridge to deliver air puffs and an app on the phone to run diagnostic tests. Credit: blinkcns

While the technology measures the same blink reflex for all situations, the ways that it can be used vary.

For TBI, which can include concussions sustained during sporting events or due to crashes or other accidents, people might be monitored daily for days or weeks. Brain changes will continue to show up while the brain heals, and being symptom-free is not necessarily an indicator of brain health. Fiorini recommends that the reflex data must reach a stable plateau before athletes get back in the game, kids go back out to recess, or people go back to work.

“We’ve had situations where people had no symptoms one day, but two days later they woke up with massive headaches, and blink testing showed that they had not yet stabilized,” he said. “If they go back to their sporting event or job too soon and have another accident, that could be really dangerous.”

For neurological diseases, the new EyeStat tool could be used for screening in doctor’s offices during routine physical exams.

“For a disease like Parkinson's, there are medicines and implants that can help, and deep brain stimulation can be very effective,” Fiorini said. “But the key is diagnosing it early. We want to get to the point where we can diagnose it before a person could detect it.”

Once a diagnosis is reached, the tool can be used to monitor disease progression and help physicians choose treatment options. With Parkinson’s disease, there are multiple medications that can work well for some people and less so for others. Right now the only way to test this is by trial and error over periods of 30 days or more to see which drugs are effective. With EyeStat monitoring, the data can show changes much more quickly.

While blinkcns has so far focused mainly on TBI and Parkinson’s disease, there are many more areas of possibility. New trials are under way to look at dry eye syndrome and ADHD, and other potential applications include early stroke detection, objective testing for substance use in drivers, and migraines.

For now, Fiorini is poised to share his device as globally as possible. “So much of neurological detection is very subjective. We want to get this out to people so they can get accurate answers,” he said. “Whether you had a concussion or you're 50 years old and you have Parkinson's that runs in your family, we want you to have the best chance for detection and healing.”

Hear more about blinkcns's technology on MUSC's Innovatively Speaking podcast episode with Ryan Fiorini!