Artificial intelligence models utilize lifestyle factors to predict dry eye related outcomes

The purpose of this study is to examine and interpret machine learning models that predict dry eye (DE)-related clinical signs, subjective symptoms, and clinician diagnoses by heavily weighting lifestyle factors in the predictions. Machine learning models were trained to take clinical assessments of the ocular surface, eyelids, and tear film, combined with symptom scores from validated questionnaire instruments for DE and clinician diagnoses of ocular surface diseases, and perform a classification into DE-related outcome categories. Outcomes are presented for which the data-driven algorithm identified subject characteristics, lifestyle, behaviors, or environmental exposures as heavily weighted predictors. Models were assessed by 5-fold cross-validation accuracy and class-wise statistics of the predictors. Age was a heavily weighted factor in predictions of eyelid notching, Line of Marx anterior displacement, and fluorescein tear breakup time (FTBUT), as well as visual analog scale symptom ratings and a clinician diagnosis of blepharitis. Comfortable contact lens wearing time was heavily weighted in predictions of DE symptom ratings. Time spent in near work, alcohol consumption, exercise, and time spent outdoors were heavily weighted predictors for several ocular signs and symptoms. Exposure to airplane cabin environments and driving a car were predictors of DE-related symptoms but not clinical signs. Prediction accuracies for DE-related symptoms ranged from 60.7 to 86.5%, for diagnoses from 73.7 to 80.1%, and for clinical signs from 66.9 to 98.7%. The results emphasize the importance of lifestyle, subject, and environmental characteristics in the etiology of ocular surface disease. Lifestyle factors should be taken into account in clinical research and care to a far greater extent than has been the case to date.