Tear fluid multi-omics and biosensor integration for diagnosis and personalized therapeutics in dry eye disease

Dry Eye Disease (DED) is increasingly recognized as a complicated, multi-factorial disease involving oxidative damage, metabolic dysregulation and immune dysregulation on the ocular surface. New data emerging from proteomics, lipidomics, metabolomics and cytokine analysis suggest that the tear film is a multi-omic window into these pathological processes. The capacity to combine these layers of omics through machine learning and data from innovative biosensors enables us to transition away from subjective methods of symptom assessment to objective, precision diagnostics. This review provides an overview of key biochemical alterations in tear fluid, revealing a mechanistic understanding and potential for clinical translation. Tear biomarkers, along with next-generation diagnostic platforms, have the potential to revolutionize DED patient care into a personalized treatment that may be valuable in predicting ocular and/or other systemic outcomes, as well as diseases of the entire body beyond the eye. Further development of multi-omic integration and real-time bio sensing technologies is anticipated to transform DED patient management.