Non invasive monitoring for spaceflight associated neuro ocular syndrome: responding to a need for In flight methodologies

Spaceflight-Associated Neuro-Ocular Syndrome (SANS) affects astronaut vision, causing refraction and acuity changes during and after long-duration missions. As space agencies plan for extended exploration, real-time SANS detection is crucial. A systematic review of PubMed and EMBASE yielded 72 relevant studies out of 196 screened. Current measurement techniques, including invasive and noninvasive intracranial pressure (ICP) assessments and novel technologies, have limitations in quantifying SANS changes and lack remote monitoring capability. Emerging tools such as telemetric ICP monitoring, optical coherence tomography (OCT), and ultrasound show promise but require further validation. Given the constraints of invasive techniques in space, non-invasive technologies should be tested in terrestrial analogs before spaceflight implementation. The precise SANS etiology will determine optimal monitoring approaches, whether ICP-focused, ocular-based, or a combination of both. No single technology can independently track SANS progression, emphasizing the need for multiparametric integration and post hoc analysis to enhance in-flight monitoring and mitigation strategies.