• Theresa Schweizer, Thomas Wyss, and Rahel Gilgen-Ammann.
• Monitoring Canton: Bern, Swiss Federal Institute of Sport Magglingen (SFISM), Magglingen/Macolin 2532, Switzerland.
• Mil Med. 2022 Mar 28; 187 (3-4): e404-e409.

IntroductionHigh physical and cognitive strain, high pressure, and sleep deficit are part of daily life for military professionals and civilians working in physiologically demanding environments. As a result, cognitive and physical capacities decline and the risk of illness, injury, or accidents increases. Such unfortunate outcomes could be prevented by tracking real-time physiological information, revealing individuals' objective fatigue levels. Oculometrics, and especially eyeblinks, have been shown to be promising biomarkers that reflect fatigue development. Head-mounted optical eye-trackers are a common method to monitor these oculometrics. However, studies measuring eyeblink detection in real-life settings have been lacking in the literature. Therefore, this study aims to validate two current mobile optical eye-trackers in an unrestrained military training environment.Materials And MethodThree male participants (age 20.0 ± 1.0) of the Swiss Armed Forces participated in this study by wearing three optical eye-trackers, two VPS16s (Viewpointsystem GmbH, Vienna, Austria) and one Pupil Core (Pupil Labs GmbH, Berlin, Germany), during four military training events: Healthcare education, orienteering, shooting, and military marching. Software outputs were analyzed against a visual inspection (VI) of the video recordings of participants' eyes via the respective software. Absolute and relative blink numbers were provided. Each blink detected by the software was classified as a "true blink" (TB) when it occurred in the software output and the VI at the same time, as a "false blink" (FB) when it occurred in the software but not in the VI, and as a "missed blink" (MB) when the software failed to detect a blink that occurred in the VI. The FBs were further examined for causes of the incorrect recordings, and they were divided into four categories: "sunlight," "movements," "lost pupil," and "double-counted". Blink frequency (i.e., blinks per minute) was also analyzed.ResultsOverall, 49.3% and 72.5% of registered eyeblinks were classified as TBs for the VPS16 and Pupil Core, respectively. The VPS16 recorded 50.7% of FBs and accounted for 8.5% of MBs, while the Pupil Core recorded 27.5% of FBs and accounted for 55.5% of MBs. The majority of FBs-45.5% and 73.9% for the VPS16 and Pupil Core, respectively-were erroneously recorded due to participants' eye movements while looking up, down, or to one side. For blink frequency analysis, systematic biases (±limits of agreement) stood at 23.3 (±43.5) and -4.87 (±14.1) blinks per minute for the VPS16 and Pupil Core, respectively. Significant differences in systematic bias between devices and the respective VIs were found for nearly all activities (P < .05).ConclusionAn objective physiological monitoring of fatigue is necessary for soldiers as well as civil professionals who are exposed to higher risks when their cognitive or physical capacities weaken. However, optical eye-trackers' accuracy has not been specified under field conditions-especially not in monitoring fatigue. The significant overestimation and underestimation of the VPS16 and Pupil Core, respectively, demonstrate the general difficulty of blink detection in the field.© The Association of Military Surgeons of the United States 2021.

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