Designing Minimally Invasive Preocular Contact Tips for Potential Application in Tear Collection

Chromophoric cerium oxide nanoparticle-loaded sucking disk-type strip sensor for optical measurement of glucose in tear fluid

BACKGROUND

Noninvasive monitoring of tear glucose levels can be convenient for patients to manage their diabetes mellitus. However, there are issues with monitoring tear glucose levels, such as the invasiveness of some methods, the miniaturization, inaccuracy, or the high cost of wearable devices. To overcome the issues, we newly designed a sucking disk-type (SD) strip biosensor that can quickly suck tear fluid and contains cerium oxide nanoparticle (CNP) that causes a unique color change according to the glucose level of the tear without complicated electronic components.

METHODS

The SD strip biosensor composed of three distinct parts (tip, channel, and reaction chamber) was designed to contain the sensing paper, onto which tear fluid can be collected and delivered. The sensing paper treated with CNP/APTS (aminopropyltriethoxysilane) /GOx (glucose oxidase) was characterized. Then we carried out the reliability of the SD strip biosensor in the diabetic rabbit animals. We quantitatively analyzed the color values of the SD strip biosensor through the colorimetric analysis algorithm.

RESULTS

We contacted the inferior palpebral conjunctiva (IPC) of a diabetic rabbit eye using an SD strip biosensor to collect tears without eye irritation and successfully verified the performance and quantitative efficacy of the sensor. An image processing algorithm that can optimize measurement accuracy is developed for accurate color change measurement of SD strip biosensors. The validation tests show a good correlation between glucose concentrations measured in the tear and blood.

CONCLUSION

Our findings demonstrate that the CNP-embedded SD strip biosensor and the associated image processing can simply monitor tear glucose to manage diabetes mellitus.

Changes in Tear Proteomic Profile in Ocular Diseases

The search for proteomic biomarkers in ocular disease is one of the most important research directions in recent years. Reliable biomarkers can be an immense adjuvant for both diagnostic and therapeutic approaches. There is no more readily available ocular tissue for proteomic analysis than tear film, which makes an interesting target for the biomarker search. Tear film is a complex fluid consisting of a superficial lipid layer, which covers the aqueous-mucous layer. Its complexity makes it a perfect candidate for all the "omics" approaches. Glaucoma, cataract, age-related macular degeneration, and other diseases are commonly thought to have a multifactorial background. Currently, no reliable non-invasive tests are available that would help physicians with screening and further patient management. The aim of the study is to present modern methods of measuring biomarkers in tears, with particular emphasis on spectrometric methods, and to discuss their diagnostic and therapeutic usefulness.

Mass spectrometry analysis of human tear fluid biomarkers specific for ocular and systemic diseases in the context of 3P medicine

Over the last two decades, a large number of non-communicable/chronic disorders reached an epidemic level on a global scale such as diabetes mellitus type 2, cardio-vascular disease, several types of malignancies, neurological and eye pathologies-all exerted system's enormous socio-economic burden to primary, secondary, and tertiary healthcare. The paradigm change from reactive to predictive, preventive, and personalized medicine (3PM/PPPM) has been declared as an essential transformation of the overall healthcare approach to benefit the patient and society at large. To this end, specific biomarker panels are instrumental for a cost-effective predictive approach of individualized prevention and treatments tailored to the person. The source of biomarkers is crucial for specificity and reliability of diagnostic tests and treatment targets. Furthermore, any diagnostic approach preferentially should be noninvasive to increase availability of the biomaterial, and to decrease risks of potential complications as well as concomitant costs. These requirements are clearly fulfilled by tear fluid, which represents a precious source of biomarker panels. The well-justified principle of a "sick eye in a sick body" makes comprehensive tear fluid biomarker profiling highly relevant not only for diagnostics of eye pathologies but also for prediction, prognosis, and treatment monitoring of systemic diseases. One prominent example is the Sicca syndrome linked to a cascade of severe complications that include dry eye, neurologic, and oncologic diseases. In this review, protein profiles in tear fluid are highlighted and corresponding biomarkers are exemplified for several relevant pathologies, including dry eye disease, diabetic retinopathy, cancers, and neurological disorders. Corresponding analytical approaches such as sample pre-processing, differential proteomics, electrophoretic techniques, high-performance liquid chromatography (HPLC), enzyme-linked immuno-sorbent assay (ELISA), microarrays, and mass spectrometry (MS) methodology are detailed. Consequently, we proposed the overall strategies based on the tear fluid biomarkers application for 3P medicine practice. In the context of 3P medicine, tear fluid analytical pathways are considered to predict disease development, to target preventive measures, and to create treatment algorithms tailored to individual patient profiles.

Preocular sensor system for concurrent monitoring of glucose levels and dry eye syndrome using tear fluids

The present study demonstrated a noninvasive preocular sensor system for the concurrent monitoring of diabetes and one of its prevalent complications, dry eye syndrome (DES), using tear fluids. Two distinct sensors, i.e., the glucose and DES sensors, were prepared and encased together in a single housing unit to produce the sensor system, and the tip was designed to be in contact with the eye surface noninvasively to collect and deliver tear fluid to the sensors. The glucose sensor was modified from a commercially available electrochemical sensor to allow for the measurement of glucose concentrations, even in a small amount of collected tear fluid. The DES sensor was equipped with a microchannel spaced with two parallel electrodes to determine the amount of collected tear fluid. In vivo experimental results revealed that with the collected tear fluid of about 0.6–1.0 μl, the sensor system estimated the blood glucose concentrations with acceptable accuracy compared with that of the glucometer in clinical use. The DES condition in animals was diagnosed with high sensitivity (91.7%) and specificity (83.3%).

Noninvasive Self-diagnostic Device for Tear Collection and Glucose Measurement

We propose a noninvasive, self-diagnostic device that enables safe tear collection and glucose measurement. The device described herein was manufactured by tight assembly of a lid for tear collection in conjunction with a strip-type glucose sensor. The lid was designed to be in contact with the inferior palpebral conjunctiva for tear collection and was thus designed to possess a proper contact area and rounded boundaries to avoid eye tissue damage. For the strip-type glucose sensor, we employed a commercially available electrochemical sensor (Accu-Chek test strips), which was modified to reduce the volume of the reaction chamber (0.4 μl) for a small amount of collected tear fluid. When tested with in vivo animal models, the device was able to collect tear fluid in a relatively short time (<2 s) without causing eye tissue damage, and the device allowed the collected tear fluid to be delivered to the sensor for measurement of tear glucose concentrations. The blood glucose concentrations estimated with the tear glucose concentrations obtained with the device exhibited a high correlation with those actually measured with a clinically available glucometer (R² = 0.9617).