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Keywords = spaceflight associated neuro-ocular syndrome

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23 pages, 1237 KiB  
Review
Risk of Permanent Corneal Injury in Microgravity: Spaceflight-Associated Hazards, Challenges to Vision Restoration, and Role of Biotechnology in Long-Term Planetary Missions
by Jainam Shah, Joshua Ong, Ryung Lee, Alex Suh, Ethan Waisberg, C. Robert Gibson, John Berdahl and Thomas H. Mader
Life 2025, 15(4), 602; https://doi.org/10.3390/life15040602 - 4 Apr 2025
Cited by 2 | Viewed by 1038
Abstract
Human space exploration presents an unparalleled opportunity to study life in extreme environments—but it also exposes astronauts to physiological stressors that jeopardize key systems like vision. Corneal health, essential for maintaining precise visual acuity, is threatened by microgravity-induced fluid shifts, cosmic radiation, and [...] Read more.
Human space exploration presents an unparalleled opportunity to study life in extreme environments—but it also exposes astronauts to physiological stressors that jeopardize key systems like vision. Corneal health, essential for maintaining precise visual acuity, is threatened by microgravity-induced fluid shifts, cosmic radiation, and the confined nature of spacecraft living environments. These conditions elevate the risk of corneal abrasions, infections, and structural damage. In addition, Spaceflight-Associated Neuro-Ocular Syndrome (SANS)—while primarily affecting the posterior segment—has also been potentially linked to anterior segment alterations such as corneal edema and tear film instability. This review examines these ocular challenges and assesses current mitigation strategies. Traditional approaches, such as terrestrial eye banking and corneal transplantation, are impractical for spaceflight due to the limited viability of preserved tissues, surgical complexities, anesthetic risks, infection potential, and logistical constraints. The paper explores emerging technologies like 3D bioprinting and stem cell-based tissue engineering, which offer promising solutions by enabling the on-demand production of personalized corneal constructs. Complementary advancements, including adaptive protective eyewear, bioengineered tear substitutes, telemedicine, and AI-driven diagnostic tools, also show potential in autonomously managing ocular health during long-duration missions. By addressing the complex interplay of environmental stressors and biological vulnerabilities, these innovations not only safeguard astronaut vision and mission performance but also catalyze new pathways for regenerative medicine on Earth. The evolution of space-based ophthalmic care underscores the dual impact of space medicine investments across planetary exploration and terrestrial health systems. Full article
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8 pages, 1512 KiB  
Perspective
Could Sleep Be an Antidote to Optic Disc Edema in Astronauts?
by Peter Wostyn and Maiken Nedergaard
Life 2025, 15(2), 183; https://doi.org/10.3390/life15020183 - 26 Jan 2025
Cited by 1 | Viewed by 1008
Abstract
A spectrum of neuro-ocular changes has been observed in astronauts during and after prolonged exposure to microgravity on long-duration spaceflights. These changes, collectively referred to as “spaceflight associated neuro-ocular syndrome” (SANS), pose a significant challenge for space agencies as they prepare for future [...] Read more.
A spectrum of neuro-ocular changes has been observed in astronauts during and after prolonged exposure to microgravity on long-duration spaceflights. These changes, collectively referred to as “spaceflight associated neuro-ocular syndrome” (SANS), pose a significant challenge for space agencies as they prepare for future human missions, including a return to the Moon and manned missions to Mars. Optic disc edema, a hallmark feature of SANS, occurs in approximately 70% of astronauts on extended missions. Recent evidence suggests a potential link between poor sleep and the development of optic disc edema in individuals exposed to a spaceflight analog environment, providing critical insights into its underlying pathophysiology. Here, we propose a novel hypothesis: sleep deprivation may increase the risk of microgravity-induced optic disc edema by altering translaminar pressure dynamics and disrupting ocular glymphatic outflow. This perspective offers a new framework for understanding SANS and highlights potential targets to mitigate its risks in the context of human space exploration. Full article
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17 pages, 4072 KiB  
Article
Artificial Gravity Attenuates the Transcriptomic Response to Spaceflight in the Optic Nerve and Retina
by Isaac Kremsky, Reyna Pergerson, Stephen Justinen, Seta Stanbouly, Jeffrey Willey, Charles A. Fuller, Satoru Takahashi, Martha Hotz Vitaterna, Mary Bouxsein and Xiaowen Mao
Int. J. Mol. Sci. 2024, 25(22), 12041; https://doi.org/10.3390/ijms252212041 - 9 Nov 2024
Cited by 1 | Viewed by 1843
Abstract
The development of eye pathology is a serious concern for astronauts who spend time in deep space. Microgravity is a major component of the spaceflight environment which could have adverse effects on ocular health. The use of centrifugation to exert forces that partially [...] Read more.
The development of eye pathology is a serious concern for astronauts who spend time in deep space. Microgravity is a major component of the spaceflight environment which could have adverse effects on ocular health. The use of centrifugation to exert forces that partially or fully mimic Earth-level gravity in space is a possible countermeasure to mitigate the effects of microgravity on the eye. Therefore, we subjected mice on the International Space Station (ISS) to microgravity (0 G) or artificial gravity by centrifugation at 0.33 G, 0.67 G, and 1 G, and then performed RNA sequencing (RNA-seq) on optic nerve and retinal tissue after returning them to Earth alive. We find that the microgravity environment induces transcriptomic changes in the optic nerve and retina consistent with an increased oxidative stress load, inflammation, apoptosis, and lipid metabolic stress. We also find that adding artificial gravity on board the ISS attenuates the transcriptomic response to microgravity in a dose-dependent manner. Such attenuation may effectively protect from and mitigate spaceflight-induced detrimental effects on ocular tissue. Full article
(This article belongs to the Section Molecular Pathology, Diagnostics, and Therapeutics)
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37 pages, 1294 KiB  
Article
Differential Functional Changes in Visual Performance during Acute Exposure to Microgravity Analogue and Their Potential Links with Spaceflight-Associated Neuro-Ocular Syndrome
by Adrian Iftime, Ioana Teodora Tofolean, Victor Pintilie, Octavian Călinescu, Stefan Busnatu and Ioana Raluca Papacocea
Diagnostics 2024, 14(17), 1918; https://doi.org/10.3390/diagnostics14171918 - 30 Aug 2024
Viewed by 1446
Abstract
Background: Spaceflight-Associated Neuro-Ocular Syndrome (SANS) is a complex pathology threatening the health of astronauts, with incompletely understood causes and no current specific functional diagnostic or screening test. We investigated the use of the differential performance of the visual system (central vs. perimacular visual [...] Read more.
Background: Spaceflight-Associated Neuro-Ocular Syndrome (SANS) is a complex pathology threatening the health of astronauts, with incompletely understood causes and no current specific functional diagnostic or screening test. We investigated the use of the differential performance of the visual system (central vs. perimacular visual function) as a candidate marker of SANS-related pathology in a ground-based microgravity analogue. Methods: We used a simple reaction time (SRT) task to visual stimuli, presented in the central and perimacular field of view, as a measure of the overall performance of the visual function, during acute settings (first 10 min) of vertical, bed rest (BR), −6°, and −15° head-down tilt (HDT) presentations in healthy participants (n = 8). We built dose–response models linking the gravitational component to SRT distribution parameters in the central vs. perimacular areas. Results: Acute exposure to microgravity induces detectable changes between SRT distributions in the perimacular vs. central retina (increased mean, standard deviation, and tau component of the ex-Gaussian function) in HDT compared with vertical presentation. Conclusions: Functional testing of the perimacular retina might be beneficial for the earlier detection of SANS-related ailments in addition to regular testing of the central vision. Future diagnostic tests should consider the investigation of the extra-macular areas, particularly towards the optic disc. Full article
(This article belongs to the Special Issue Visual Impairment: Diagnosis and Management)
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9 pages, 1389 KiB  
Communication
Self-Generated Lower Body Negative Pressure Exercise: A Low Power Countermeasure for Acute Space Missions
by Suhas Rao Velichala, Ryan D. Kassel, Victoria Ly, Donald E. Watenpaugh, Stuart M. C. Lee, Brandon R. Macias and Alan R. Hargens
Life 2024, 14(7), 793; https://doi.org/10.3390/life14070793 - 24 Jun 2024
Cited by 1 | Viewed by 1677
Abstract
Microgravity in spaceflight produces headward fluid shifts which probably contribute to Spaceflight-Associated Neuro-Ocular Syndrome (SANS). Developing new methods to mitigate these shifts is crucial for preventing SANS. One possible strategy is the use of self-generated lower body negative pressure (LBNP). This study evaluates [...] Read more.
Microgravity in spaceflight produces headward fluid shifts which probably contribute to Spaceflight-Associated Neuro-Ocular Syndrome (SANS). Developing new methods to mitigate these shifts is crucial for preventing SANS. One possible strategy is the use of self-generated lower body negative pressure (LBNP). This study evaluates biological or physiological effects induced by bed rest to simulate adaptations to microgravity. Participants were tested during powered LBNP and dynamic self-generated (SELF) LBNP at 25 mmHg for 15 min. The results were compared to the physiologic responses observed in seated upright and supine positions without LBNP, which served as controls for normal gravitational effects on fluid dynamics. Eleven participants’ (five male, six female) heart rates, blood pressures, and cross-sectional areas (CSA) of left and right internal jugular veins (IJV) were monitored. Self-generated LBNP, which requires mild to moderate physical activity, significantly elevated heart rate and blood pressure (p < 0.01). Self-generated LBNP also significantly reduced right IJV CSA compared to supine position (p = 0.005), though changes on the left side were not significant (p = 0.365). While the effects of SELF and traditional LBNP on IJV CSA were largely similar, traditional LBNP significantly reduced IJV CSA on both sides. Given its low mass, volume, and power requirements, SELF LBNP is a promising countermeasure against SANS. Results from this study warrant longer-term studies of SELF LBNP under simulated spaceflight conditions. Full article
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12 pages, 608 KiB  
Review
Ultrasound Biomicroscopy as a Novel, Potential Modality to Evaluate Anterior Segment Ophthalmic Structures during Spaceflight: An Analysis of Current Technology
by Benjamin Soares, Joshua Ong, Daniela Osteicoechea, Cihan Mehmet Kadipasaoglu, Ethan Waisberg, Prithul Sarker, Nasif Zaman, Alireza Tavakkoli, Gianmarco Vizzeri and Andrew G. Lee
Diagnostics 2024, 14(6), 639; https://doi.org/10.3390/diagnostics14060639 - 18 Mar 2024
Cited by 3 | Viewed by 2707
Abstract
Ocular health is currently a major concern for astronauts on current and future long-duration spaceflight missions. Spaceflight-associated neuro-ocular syndrome (SANS) is a collection of ophthalmic and neurologic findings that is one potential physiologic barrier to interplanetary spaceflight. Since its initial report in 2011, [...] Read more.
Ocular health is currently a major concern for astronauts on current and future long-duration spaceflight missions. Spaceflight-associated neuro-ocular syndrome (SANS) is a collection of ophthalmic and neurologic findings that is one potential physiologic barrier to interplanetary spaceflight. Since its initial report in 2011, our understanding of SANS has advanced considerably, with a primary focus on posterior ocular imaging including fundus photography and optical coherence tomography. However, there may be changes to the anterior segment that have not been identified. Additional concerns to ocular health in space include corneal damage and radiation-induced cataract formation. Given these concerns, precision anterior segment imaging of the eye would be a valuable addition to future long-duration spaceflights. The purpose of this paper is to review ultrasound biomicroscopy (UBM) and its potential as a noninvasive, efficient imaging modality for spaceflight. The analysis of UBM for spaceflight is not well defined in the literature, and such technology may help to provide further insights into the overall anatomical changes in the eye in microgravity. Full article
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10 pages, 260 KiB  
Entry
Intraocular Pressure during Spaceflight and Risk of Glaucomatous Damage in Prolonged Microgravity
by Mouayad Masalkhi, Joshua Ong, Ethan Waisberg, John Berdahl and Andrew G. Lee
Encyclopedia 2023, 3(4), 1187-1196; https://doi.org/10.3390/encyclopedia3040086 - 28 Sep 2023
Cited by 8 | Viewed by 3762
Definition
Microgravity introduces diverse pathological and various physiological changes to the human body, including intraocular pressure. Astronauts may develop a constellation of symptoms and signs including optic disc edema, choroidal folds, and a hyperopic shift from the flattening of the globe. These ocular findings [...] Read more.
Microgravity introduces diverse pathological and various physiological changes to the human body, including intraocular pressure. Astronauts may develop a constellation of symptoms and signs including optic disc edema, choroidal folds, and a hyperopic shift from the flattening of the globe. These ocular findings have been collectively termed spaceflight-associated neuro-ocular syndrome (SANS). SANS is a condition that is unique to long-duration spaceflight. The precise pathogenesis of SANS remains ill-defined, but several hypotheses have been proposed that may be influenced by intraocular pressure. Countermeasures for SANS research also include techniques that impact intraocular pressure. In this article, we discuss intraocular pressure during spaceflight, the translaminar pressure gradient, SANS and potential SANS countermeasures, and the potential for glaucomatous damage during spaceflight. Full article
(This article belongs to the Collection Encyclopedia of Glaucoma)
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21 pages, 4745 KiB  
Review
Artificial Intelligence Frameworks to Detect and Investigate the Pathophysiology of Spaceflight Associated Neuro-Ocular Syndrome (SANS)
by Joshua Ong, Ethan Waisberg, Mouayad Masalkhi, Sharif Amit Kamran, Kemper Lowry, Prithul Sarker, Nasif Zaman, Phani Paladugu, Alireza Tavakkoli and Andrew G. Lee
Brain Sci. 2023, 13(8), 1148; https://doi.org/10.3390/brainsci13081148 - 30 Jul 2023
Cited by 29 | Viewed by 6811
Abstract
Spaceflight associated neuro-ocular syndrome (SANS) is a unique phenomenon that has been observed in astronauts who have undergone long-duration spaceflight (LDSF). The syndrome is characterized by distinct imaging and clinical findings including optic disc edema, hyperopic refractive shift, posterior globe flattening, and choroidal [...] Read more.
Spaceflight associated neuro-ocular syndrome (SANS) is a unique phenomenon that has been observed in astronauts who have undergone long-duration spaceflight (LDSF). The syndrome is characterized by distinct imaging and clinical findings including optic disc edema, hyperopic refractive shift, posterior globe flattening, and choroidal folds. SANS serves a large barrier to planetary spaceflight such as a mission to Mars and has been noted by the National Aeronautics and Space Administration (NASA) as a high risk based on its likelihood to occur and its severity to human health and mission performance. While it is a large barrier to future spaceflight, the underlying etiology of SANS is not well understood. Current ophthalmic imaging onboard the International Space Station (ISS) has provided further insights into SANS. However, the spaceflight environment presents with unique challenges and limitations to further understand this microgravity-induced phenomenon. The advent of artificial intelligence (AI) has revolutionized the field of imaging in ophthalmology, particularly in detection and monitoring. In this manuscript, we describe the current hypothesized pathophysiology of SANS and the medical diagnostic limitations during spaceflight to further understand its pathogenesis. We then introduce and describe various AI frameworks that can be applied to ophthalmic imaging onboard the ISS to further understand SANS including supervised/unsupervised learning, generative adversarial networks, and transfer learning. We conclude by describing current research in this area to further understand SANS with the goal of enabling deeper insights into SANS and safer spaceflight for future missions. Full article
(This article belongs to the Special Issue Recent Advances in Neuro-Opthalmology)
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15 pages, 3513 KiB  
Article
Antioxidants Derived from Natural Products Reduce Radiative Damage in Cultured Retinal Glia to Prevent Oxidative Stress
by Richard N. Cliver, Natalia Castro, Thais Russomano, Gaetano Lardieri, Lindsay Quarrie, Helena van der Merwe and Maribel Vazquez
Neuroglia 2022, 3(3), 84-98; https://doi.org/10.3390/neuroglia3030006 - 20 Jul 2022
Cited by 5 | Viewed by 5518
Abstract
Retinal pathologies have been heavily studied in response to radiation and microgravity, including spaceflight-associated neuro-ocular syndrome (SANS), which is commonly developed in space flight. SANS has been characterized in clinical studies of astronauts returning to Earth and includes a range of symptoms, such [...] Read more.
Retinal pathologies have been heavily studied in response to radiation and microgravity, including spaceflight-associated neuro-ocular syndrome (SANS), which is commonly developed in space flight. SANS has been characterized in clinical studies of astronauts returning to Earth and includes a range of symptoms, such as globe flattening, optic-disc edema, retinal folds, and retinal ischemia. In cases of retinal insult, Müller glia (MG) cells respond via neuroprotective gliotic responses that may become destructive to produce glial scarring and vison loss over time. Retinal pathology is further impacted by the production of excessive reactive oxygen species (ROS) that stimulate retinal inflammation and furthers the gliosis of MG. Neuroprotectants derived from natural products (NPs) able to scavenge excess ROS and mitigate long-term, gliotic responses have garnered recent interest, especially among mature and aging adults. The natural antioxidants aloin and ginkgolide A flavonoids, derived from Aloe vera and Ginkgo biloba species, respectively, have been of particular interest due to their recent use in other nervous-system studies. The current study examined MG behaviors in response to different doses of aloin and ginkgolide A over time by measuring changes in morphology, survival, and ROS production within microscale assays. The study was further enhanced by using galactic cosmic rays (GCR) at the Brookhaven NASA Space Radiation Laboratory to simulate ionizing radiation in low- and high-radiation parameters. Changes in the survival and ROS production of radiation-treated MG were then measured in response to varying dosage of NPs. Our study used in vitro systems to evaluate the potential of NPs to reduce oxidative stress in the retina, highlighting the underexplored interplay between NP antioxidants and MG endogenous responses both in space and terrestrially. Full article
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10 pages, 14349 KiB  
Review
Cardiovascular, Lymphatic, and Ocular Health in Space
by Victoria Ly, Suhas Rao Velichala and Alan R. Hargens
Life 2022, 12(2), 268; https://doi.org/10.3390/life12020268 - 11 Feb 2022
Cited by 18 | Viewed by 4669
Abstract
Life on Earth has evolved continuously under Earth’s 1 G force and the protection of the magnetosphere. Thus, astronauts exhibit maladaptive physiological responses during space travel. Exposure to harmful cosmic radiation and weightlessness are unique conditions to the deep-space environment responsible for several [...] Read more.
Life on Earth has evolved continuously under Earth’s 1 G force and the protection of the magnetosphere. Thus, astronauts exhibit maladaptive physiological responses during space travel. Exposure to harmful cosmic radiation and weightlessness are unique conditions to the deep-space environment responsible for several spaceflight-associated risks: visual impairment, immune dysfunction, and cancer due to cosmic radiation in astronauts. The evidence thus reviewed indicates that microgravity and cosmic radiation have deleterious effects on the cardiovascular, lymphatic, and vision systems of astronauts on long-duration space missions. The mechanisms responsible for the decline in these systems are potentially due to cytoskeletal filament rearrangement, endothelial dysfunction, and muscular atrophy. These factors may alter fluid hemodynamics within cardiovascular and lymphatic vasculatures such that greater fluid filtration causes facial and intracranial edema. Thus, microgravity induces cephalad fluid shifts contributing to spaceflight-associated neuro-ocular syndrome (SANS). Moreover, visual impairment via retinal ischemia and altered nitric oxide production may alter endothelial function. Based on rodent studies, cosmic radiation may exacerbate the effects of microgravity as observed in impaired endothelium and altered immunity. Relevant findings help understand the extent of these risks associated with spaceflight and suggest relevant countermeasures to protect astronaut health during deep-space missions. Full article
(This article belongs to the Special Issue Space Flight Factors and Cytoskeleton Organization)
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