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ABSTRACT
Introduction
Over the last decade, many neuro-ocular findings have been documented following long-duration spaceflight (LDSF) including optic disc edema, choroidal folds, hyperopic refractive shift, and cotton wool spots. These are currently classified under the term Spaceflight-Associated Neuro-Ocular Syndrome (SANS). SANS is unique to space flight with no direct terrestrial analog. The exact pathogenesis is a subject of much debate and poses questions about the long-term impact of SANS on future human spaceflight missions.
Areas Covered
In this review, we explore the current understanding of SANS including the different proposed etiologies and comparable terrestrial analogs. A systematic but selective review of literature published about SANS and related ocular diseases was conducted. Databases searched include PubMed and Scopus. This information was used to generate a review on potential mechanisms and analogs related to SANS.
Expert Opinion
This review discusses the current status and future directions for SANS research, the role private space companies play in increasing access to space flight, and the possibility of future high-quality human spaceflight research in microgravity. We hope that the work on SANS can inspire technological innovation, increase our knowledge of terrestrial disorders, and possibly creating downstream spin-off technologies that have wider applications beyond space flight alone.
Article highlights
Spaceflight-Associated Neuro-ocular Syndrome (SANS)
SANS is a unique neuro-ocular condition of space flight that has no terrestrial analog. SANS presents a potential barrier to future deep-space missions and manned lunar/Martian missions and/or colonization. The defining features of SANS include hyperopic shift, optic disc edema, choroidal folds, globe flattening, and retinal nerve fiber layer infarcts (i.e., cotton wool patches).
The etiology underlying SANS is not entirely understood and remains a subject of much debate. Several potential mechanisms exist including cephalic fluid shift, vascular and lymphatic congestion, inflammation, ischemia and environmental factors. Although SANS has no direct terrestrial equivalent, SANS does share many features with several terrestrial disorders which may provide insight into the pathogenesis of SANS.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.