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Eye research critical for future long-term NASA missions
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Approximately 2 years ago, Randy McDonald of the Magnum Group called me with a special request. Dorit B. Donoviel, PhD, the deputy chief scientist and industry forum lead for NASA’s National Space Biomedical Research Institute, had asked him to put together a blue ribbon panel to review the at the time so-called visual impairment and intracranial pressure, or VIIP, syndrome that was affecting some astronauts after extended space travel. The syndrome included a hyperopic shift, choroidal folds and, in some cases, optic disc edema. A few astronauts had demonstrated cotton wool patches. No one had lost any vision permanently, but the hyperopia did not resolve after returning to earth. Elevated intracranial pressure had not been confirmed in any astronauts, and there were no associated headaches, pupil abnormalities or other neurological symptoms.
Randy asked Eugene de Juan, MD, Kuldev Singh, MD, Steve Schallhorn, MD, John Berdahl, MD, and me to review the data, attend an extended briefing and visit the NSBRI in Houston for a think tank on this syndrome that was puzzling to NASA scientists and potentially putting the mission to Mars program at risk. The think tank was labeled Vision for Mars, and we were all extraordinarily honored to be involved. We were asked to keep our personal thoughts and opinions confidential until the meeting, which was attended by a combination of astronauts, administrators, scientists and doctors.
My comprehensive review of the world literature revealed a similar rare syndrome on Earth named by some as benign hyperopic shift associated with choroidal folds. A few earthbound patients with this syndrome had demonstrated optic disc abnormalities or edema. On a very positive note, while the hyperopic shift was permanent, no one had suffered permanent loss of vision or had been found to have elevated cerebrospinal fluid (CSF) pressure, allowing the syndrome to be labeled benign. This was in contrast to the far more threatening idiopathic intracranial hypertension syndrome, which occurred most frequently in obese women and was associated with elevated CSF pressure, loss of vision and significant morbidity. I found it interesting that the benign earthbound syndrome associated with hyperopic shift and choroidal folds occurred almost exclusively in men. Most NASA astronauts are male in gender, and at that time VIIP syndrome had only been reported in men.
This think tank catalyzed useful thinking and further research, including a study of the possible genetic and gender differences. The benign nature of the ocular findings continues to be reassuring, but a mission to Mars would extend our astronauts’ space travel to as long as 2 to 3 years. The potential for permanent vision loss remains, and the research continues.
The syndrome has been renamed spaceflight-associated neuro-ocular syndrome (SANS). To date, no permanent neurological findings have been confirmed, nor has any elevation of CSF pressure. Spaceflight-associated ocular syndrome might be an even better name if the findings continue to be restricted to the eye.
The Vision for Mars project allowed me an insight into NASA’s NSBRI. It was founded in 1997 and is located adjacent to Baylor University in Houston. The director is Jeffrey P. Sutton, MD, PhD. The NSBRI has affiliation agreements with nearly 70 research institutions and universities. The quality of the personnel, their obvious dedication to the health and well-being of our astronauts, and their access to an unlimited cohort of consultants were immediately obvious. The location of the NSBRI adjacent to Baylor University prompted Baylor to establish a Center for Space Medicine and the Translational Research Institute for Space Health in 2008. Both the NASA NSBRI and Baylor University programs allow interested research students and scientists to apply for opportunities to participate in their interesting and critical research.
The absolute necessity that our astronauts retain quality vision during any mission, especially one extending as long as the 2 to 3 years required for a trip to Mars, has put ophthalmology in the middle of the mission to Mars effort. My small experience interacting with the NASA team was nothing short of amazing and another reason I am proud to be an American.
Disclosure: Lindstrom reports he is on the board of directors of and is an equity owner and consultant to Equinox.