Currently submitted to: Journal of Medical Internet Research
Date Submitted: Apr 17, 2026
Open Peer Review Period: Apr 18, 2026 - Jun 13, 2026
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Wearable Eye-Tracking Metrics From Smart Glasses for Cognitive Assessment: A Prospective Digital Health Study
ABSTRACT
Background:
Reading performance is closely associated with cognitive function, and eye-tracking metrics have emerged as sensitive, non-invasive indicators of cognitive processes. Recent advances in wearable technologies, such as smart glasses, enable continuous and scalable measurement of eye movements in real-world settings. However, rapid, accessible, and objective tools for cognitive screening remain limited. Integrating wearable eye-tracking with multidomain cognitive assessment may provide a scalable digital approach for early detection of cognitive impairment.
Objective:
To evaluate the association between wearable eye-tracking metrics and cognitive performance and to assess the feasibility of a smart glasses–based reading task as a rapid digital screening tool.
Methods:
In this prospective observational study, Mandarin-literate adults were recruited from Taipei Veterans General Hospital between May to August 2025. Participants completed a standardized reading task while wearing J7EF Gaze smart glasses. Eight eye-tracking metrics were recorded, followed by the six-domain cognitive assessment using gaze-based interaction. Associations were analyzed via multivariable regression adjusted for age and sex.
Results:
A total of 134 participants were enrolled (mean age 68.2 ± 13.4 years). Age correlated with all six cognitive domains and the total score, while sex exhibited smaller, domain-specific effects. In unadjusted analyses, total reading time showed the strongest associations with all cognitive domains (p < 0.001), while fixation duration, fixation frequency, and long or ultra-long fixations showed selective associations with orientation. After adjusting for age and sex, total reading time, total fixation time and average fixation time remained significant predictors.
Conclusions:
Total reading time emerged as a robust, age-independent eye-tracking marker of cognitive performance. Fixation-related metrics showed domain-specific associations, particularly with the puzzle game hobbies domain of the cognitive assessment. Wearable smart glasses with integrated eye tracking may provide a rapid, non-invasive, and scalable approach for digital cognitive screening in clinical and real-world settings.
Citation
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