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At least 19 records
All sourcesNASA NTRSDOE OSTI
NASA NTRS2004

An Ophthalmologic Summit for On-Orbit Care

Ophthalmologic issues are a source of concern for NASA flight surgeons, due to the remote nature of the space station as well as the microg ravity environment. Methods: A panel of external consultants was conv ened to evaluate the adequacy of the current in-flight medical system for the diagnosis and treatment of ophthalmologic issues. Participants were acknowledged experts in their field who also had experience in operational medicine. Results: Nine extramural experts provided assi stance, and six of them participated in a face to face meeting held a t NASA-Johnson Space Center. Changes were recommended for the space s tation pharmacopoeia, and diagnostic, therapeutic, and deorbit criteria protocols for a variety of ocular conditions were developed. Discus sion: The results of the panel provide an evidence based approach to the diagnosis and care of ophthalmologic conditions on the International Space Station

Bacal, Kira↗
NASA NTRS1999

Late ophthalmological complications after total body irradiation in non-human primates

PURPOSE: To investigate the long-term effects of total body irradiation (TBI) on the incidence and time course of ocular complications. MATERIALS AND METHODS: Rhesus monkeys treated with TBI photon doses up to 8.5 Gy and proton doses up to 7.5 Gy were studied at intervals up to 25 years post-irradiation. They were compared with control groups with a similar age distribution. Cataract formation and ocular fundus lesions were scored according to a standardized protocol. Fluorescein angiography and histopathology was performed in selected animals. RESULTS: Cataract formation occurred after a latent period of 3-5 years. Significant cataract induction was observed for photon-doses of 8 and 8.5 Gy and beyond 20 years after proton irradiation. The severity of the lesions represents significant impairment of vision and would require cataract surgery if similar results occurred in human bone marrow transplant patients. Fluorescein angiography demonstrated a normal pattern of retinal vessels in 13 out of 14 animals (93%) from the irradiated group and in eight out of nine animals (89%) from the control group. No additional lesions apart from age-related degenerative changes could be demonstrated. Histological evaluation revealed no radiation-associated vasculopathy. CONCLUSIONS: Radiation alone for doses up to 8.5 Gy of photons does not carry a potential risk for fundus pathology, whereas clinically important cataract induction should be anticipated within 5 years after photon doses of 8.0 and 8.5 Gy and proton doses in excess of 2.5 Gy.

NASA Discipline Radiation Health↗
NASA NTRS2015

Ocular Outcomes Comparison Between 14- and 70-day Head-down Tilt Bed Rest

INTRODUCTION: Ophthalmological changes, including optic disc edema with optic nerve sheath distension, posterior globe flattening with hyperopic shift, choroidal folds and cotton wool spots have been detected in some astronauts involved in long-duration spaceflights. (sup 1) It is hypothesized that elevated intracranial pressure resulting from microgravity-induced cephalad fluid shifts may be responsible for most of these findings. Head-down tilt bed rest (HTDBR) is a ground-based microgravity analog which also produces cephalad fluid shifts. It is conceivable that prolonged HDTBR exposure may induce ocular changes similar to those experienced in microgravity. Therefore, the purpose of the present study was to compare structural and functional ocular outcomes between 14- and 70-day HDTBR in healthy human subjects. It is hypothesized that 70-d HDTBR induced ocular changes of greater magnitude as compared to 14-d HDTBR. METHODS: Two HDTBR studies were conducted at the NASA Flight Analogs Research Unit, located at The University of Texas Medical Branch at Galveston, TX. Identical NASA standard screening procedures and BR conditions (e.g., strict sleep-wake cycle, standardized diet, continuous video monitoring) were implemented in both studies. Participants spent 14 and/or 70 consecutive days in a 6deg HDT position and did not engage in exercise. Subjects received weekly ocular examinations before, during, and after HDTBR. Ocular testing included: distance and near best-corrected visual acuity (BCVA), cycloplegic refraction, intraocular pressure (IOP) measurement, color vision, red dot test, modified Amsler grid test, confrontational visual field, color fundus photography and Spectral-domain OCT scans of the macula and the optic disc. Pre/post HDTBR differences between the two studies will be evaluated for BCVA, spherical equivalent, IOP, retinal nerve fiber layer (RNFL) thickness and macular OCT parameters. RESULTS: 16 (12 males and 4 females) and 6 (5 males and 1 female) subjects participated in the 14 and 70-day HDTBR studies, respectively. One subject participated in both studies. The demographic and ophthalmological characteristics of the 14-day HDTBR study have been presented elsewhere.2 In the 70- day study, subjects age averaged 39.5 +/- 7.8 years; pre- and post-HDTBR Goldmann IOP were, on average, 15.4 and 14.6 mmHg in the right eye, and 15.3 and 14.4 mmHg in the left eye, respectively; preand post-HDTBR Spectralis OCT (Heidelberg Engineering, GmbH, Heidelberg, Germany) average RNFL thickness were 103.8 and 106 μm in the right eye, and 103 and 104.3 μm in the left eye, respectively. In both studies, color vision, red dot test, modified Amsler grid test and confrontational visual field were within normal limits at all time points; no changes were detected on stereoscopic color optic disc photography. For the above outcomes, preliminary results of the pre/post HDTBR differences between the two studies will be presented at the 2015 Human Research Program Investigators' Workshop. CONCLUSIONS: Although 14-day HDTBR did not seem to induce clinically relevant ocular changes, (sup 2) a systematic evaluation and comparison with the 70-day HDTBR study results will elucidate whether the magnitude of ocular structural and functional changes is affected by the time spent in the recumbent position. Further research will also address the effects of integrated resistance and aerobic training during HDTBR on the ocular outcomes. REFERENCES: 1. Mader TH et al. Optic disc edema, globe flattening, choroidal folds, and hyperopic shifts observed in astronauts after long-duration space flight. Ophthalmology. 2011;118(10):2058-69. 2. Taibbi G et al. Ocular outcomes evaluation in a 14-day head-down bed rest study. Aviat Space Environ Med. 2014;85(10):983-92.

Cromwell, R.L.↗
NASA NTRS1969

Lasers in biology and medicine

Laser applications in biology and medicine covering surgery, ophthalmology, microorganisms, viruses, tissue culture, tumor eradication, radiation hazards, etc

Fine, S.↗
NASA NTRS1979

Intraocular pressure reduction and regulation

System designed to reduce intraocular pressure hydraulically to any level desired by physician over set time and in controlled manner has number of uses in ophthalmology. Device may be most immediately useful in treatment of glaucoma.

Baehr, E. F.↗
NASA NTRS1985

Test and evaluation of the 2.4-micron photorefractor ocular screening system

An improved 2.4-m photorefractor ocular screening system was tested and evaluated. The photorefractor system works on the principal of obtaining a colored photograph of both human eyes; and, by analysis of the retinal reflex images, certain ocular defects can be detected such a refractive error, strabismus, and lens obstructions. The 2.4-m photorefractory system uses a 35-mm camera with a telephoto lens and an electronic flash attachment. Retinal reflex images obtained from the new 2.4-m system are significantly improved over earlier systems in image quality. Other features were also improved, notably portability and reduction in mass. A total of 706 school age children were photorefracted, 211 learning disabled and 495 middle school students. The total students having abnormal retinal reflexes were 156 or 22 percent, and 133 or 85 percent of the abnormal had refractive error indicated. Ophthalmological examination was performed on 60 of these students and refractive error was verified in 57 or 95 percent of those examined. The new 2.4-m system has a NASA patent pending and is authorized by the FDA. It provides a reliable means of rapidly screening the eyes of children and young adults for vision problems. It is especially useful for infants and other non-communicative children who cannot be screened by the more conventional methods such as the familiar E chart.

Richardson, J. R.↗
NASA NTRS1988

Clinical applications of computerized thermography

Computerized or digital, thermography is a rapidly growing diagnostic imaging modality. It has superseded contact thermography and analog imaging thermography which do not allow effective quantization. Medical applications of digital thermography can be classified in two groups: static and dynamic imaging. They can also be classified into macro thermography (resolution greater than 1 mm) and micro thermography (resolution less than 100 microns). Both modalities allow a thermal resolution of 0.1 C. The diagnostic power of images produced by any of these modalities can be augmented by the use of digital image enhancement and image recognition procedures. Computerized thermography has been applied in neurology, cardiovascular and plastic surgery, rehabilitation and sports medicine, psychiatry, dermatology and ophthalmology. Examples of these applications are shown and their scope and limitations are discussed.

Anbar, Michael↗
NASA NTRS1994

High power diode lasers for solid-state laser pumps

The development and commercial application of high power diode laser arrays for use as solid-state laser pumps is described. Such solid-state laser pumps are significantly more efficient and reliable than conventional flash-lamps. This paper describes the design and fabrication of diode lasers emitting in the 780 - 900 nm spectral region, and discusses their performance and reliability. Typical measured performance parameters include electrical-to-optical power conversion efficiencies of 50 percent, narrow-band spectral emission of 2 to 3 nm FWHM, pulsed output power levels of 50 watts/bar with reliability values of over 2 billion shots to date (tests to be terminated after 10 billion shots), and reliable operation to pulse lengths of 1 ms. Pulse lengths up to 5 ms have been demonstrated at derated power levels, and CW performance at various power levels has been evaluated in a 'bar-in-groove' laser package. These high-power 1-cm stacked-bar arrays are now being manufactured for OEM use. Individual diode laser bars, ready for package-mounting by OEM customers, are being sold as commodity items. Commercial and medical applications of these laser arrays include solid-state laser pumping for metal-working, cutting, industrial measurement and control, ranging, wind-shear/atmospheric turbulence detection, X-ray generation, materials surface cleaning, microsurgery, ophthalmology, dermatology, and dental procedures.

Linden, Kurt J.↗
NASA NTRS2009

Three-Dimensional Optical Coherence Tomography

Three-dimensional (3D) optical coherence tomography (OCT) is an advanced method of noninvasive infrared imaging of tissues in depth. Heretofore, commercial OCT systems for 3D imaging have been designed principally for external ophthalmological examination. As explained below, such systems have been based on a one-dimensional OCT principle, and in the operation of such a system, 3D imaging is accomplished partly by means of a combination of electronic scanning along the optical (Z) axis and mechanical scanning along the two axes (X and Y) orthogonal to the optical axis. In 3D OCT, 3D imaging involves a form of electronic scanning (without mechanical scanning) along all three axes. Consequently, the need for mechanical adjustment is minimal and the mechanism used to position the OCT probe can be correspondingly more compact. A 3D OCT system also includes a probe of improved design and utilizes advanced signal- processing techniques. Improvements in performance over prior OCT systems include finer resolution, greater speed, and greater depth of field.

Gutin, Mikhail↗
NASA NTRS2010

A Novel Method for Quantifying Helmeted Field of View of a Spacesuit - And What It Means for Constellation

Field of view has always been a design feature paramount to helmet design, and in particular spacesuit design, where the helmet must provide an adequate field of view for a large range of activities, environments, and body positions. Historically, suited field of view has been evaluated either qualitatively in parallel with design or quantitatively using various test methods and protocols. As such, oftentimes legacy suit field of view information is either ambiguous for lack of supporting data or contradictory to other field of view tests performed with different subjects and test methods. This paper serves to document a new field of view testing method that is more reliable and repeatable than its predecessors. It borrows heavily from standard ophthalmologic field of vision tests such as the Goldmann kinetic perimetry test, but is designed specifically for evaluating field of view of a spacesuit helmet. In this test, four suits utilizing three different helmet designs were tested for field of view. Not only do these tests provide more reliable field of view data for legacy and prototype helmet designs, they also provide insight into how helmet design impacts field of view and what this means for the Constellation Project spacesuit helmet, which must meet stringent field of view requirements that are more generous to the crewmember than legacy designs.

McFarland, Shane M.↗
NASA NTRS2013

Fluid Shifts Before, During, and After Prolonged Space Flight and their Association with Intracranial Pressure and Visual Impairment

With the conclusion of the Space Shuttle program, NASA is focusing on long-duration missions on the International Space Station (ISS) and future exploration-class missions beyond low Earth orbit. Visual acuity changes observed in Space Shuttle crewmembers after their short-duration missions were largely transient, but more than 30% of ISS astronauts experience more profound changes in vision, some with objective structural and functional findings such as papilledema and choroidal folds on ophthalmologic examination. Globe flattening, optic nerve sheath dilatation, optic nerve tortuosity, and other findings have been noted in imaging studies. This pattern is referred to as visual impairment and intracranial pressure (VIIP) syndrome. The VIIP signs and symptoms, as well as postflight lumbar puncture data, suggest that elevated intracranial pressure (ICP) is associated with the space flight-induced cephalad fluid shifts, but this hypothesis has not been systematically tested. The purpose of this study is to objectively characterize the fluid distribution and compartmentalization associated with long-duration space flight, and to correlate the findings with vision changes and other elements of the VIIP syndrome. We also seek to determine whether the magnitude of fluid shifts during space flight, as well as the VIIP-related effects of those shifts, can be predicted by crewmember baseline data and responses to acute hemodynamic manipulations (such as head-down tilt tests) obtained before flight. Lastly, we will evaluate the patterns of fluid distribution in astronaut subjects on the ISS during the use of lower body negative pressure (LBNP) and respiratory maneuvers to characterize and explain general and individual responses during space flight.

Stenger, M.↗
NASA NTRS2016

Comparison of Structural and Functional Ocular Outcomes Between 14- and 70 Day Bed Rest

Purpose: To compare structural and functional ocular outcomes in healthy human subjects undergoing 14- and/or 70-day head-down-tilt bed rest (HDTBR). We hypothesized the amount of HDTBR-induced ocular changes be affected by the HDTBR duration. Methods: The studies were conducted at the NASA Flight Analogs Research Unit, The University of Texas Medical Branch at Galveston, Galveston, TX. Participants were selected using NASA standard screening procedures. Standardized NASA screening procedures and bed rest conditions (e.g., strict sleep-wake cycle, standardized diet, continuous video monitoring) were implemented in both studies. Participants maintained a 6deg HDTBR position for 14 and/or 70 consecutive days and did not engage in exercise. Weekly ophthalmological examinations were conducted in the sitting (pre/post-bed rest only) and HDT positions. Ocular outcomes of interest included: near best-corrected visual acuity (BCVA); spherical equivalent, as determined by cycloplegic autorefraction; Goldmann applanation tonometry and iCare (Icare Finland Oy, Espoo, Finland) intraocular pressure (IOP) measurement; color vision; red dot test; modified Amsler grid test; confrontational visual field; stereoscopic color fundus photography; Spectralis OCT (Heidelberg Engineering, GmbH, Heidelberg, Germany) retinal nerve fiber layer thickness (RNFLT), peripapillary and macular retinal thicknesses. Mixed-effects linear models were used to compare pre- and post-HDTBR observations between 14- and 70-day HDTBR for our continuously scaled outcomes.

Cromwell, R. L.↗
NASA NTRSDate not supplied

One-Carbon Metabolism and SANS 2022 Update

Spaceflight Associated Neuro-ocular Syndrome, or SANS, affects a subset of astronauts (1, 2), and biochemical evidence has documented differences in those astronauts (3). Specifically, they had higher circulating concentrations of metabolites of the one-carbon metabolic pathway (1C), including homocysteine, and these concentrations were higher before flight (3). After ruling out many potential confounding factors in these otherwise healthy individuals (e.g., sex, kidney function, vitamin status, coffee consumption), a study of genetics was warranted. In an initial pilot effort, we documented a genetic predisposition to develop ophthalmic changes after long-duration space flight (4). That is, from a limited study of 5 single-nucleotide polymorphisms (SNPs), we found that the G allele for the MTRR A66G SNP was associated with a greater risk of choroidal folds and cotton-wool spots after flight, and the C allele for SHMT1 C1420T was protective against optic disc edema (4). These data provide a potential pathway for understanding why some individuals develop SANS, while others do not. The initial pilot study of 5 SNPs yielded striking findings, but the 1C pathway is far more complex. An effort was undertaken to examine more than 500 1C SNPs to see if a broader examination could help illuminate this association. That work is ongoing. The astronaut findings led us to advocate for the inclusion of 1C pathway genetic and biochemistry testing on other SANS-related projects, noting that genetics might help identify responders, non-responders, or outliers. The first such effort yielded evidence of an association of specific forms of the MTRR and SHMT-1 SNPs and vitamin B12 status with end-tidal CO2 after acute carbon dioxide exposure (5). The second such effort led to the identification that individuals exposed to strict head-down tilt and CO2 for 30-d who developed optic disc edema also had risk alleles for the two SNPs described above (6). Additionally, we identified a clinical population with many characteristics either attributed or purported to be involved in the ocular changes seen in affected astronauts: women with polycystic ovary syndrome (PCOS). PCOS is a condition of androgen excess and anovulatory menstrual cycles. The shared characteristics and clinical findings between SANS and PCOS generally include higher circulating homocysteine concentrations, increased retinal nerve fiber layer thickness, increased androgen concentrations (or responses), and altered carbohydrate metabolism. To our knowledge, no study has examined whether women with PCOS have asymptomatic ophthalmic anomalies observed in astronauts with SANS. While researchers have evaluated the one-carbon metabolism pathway polymorphisms of PCOS patients, and initial studies show an association with certain one-carbon polymorphisms, none have looked at the set of SNPs identified in our studies that are associated with ophthalmic changes in astronauts. Accordingly, we designed a study to evaluate the association of one-carbon pathway SNPs and ophthalmic findings in patients with PCOS and/or IIH compared to controls. Subjects provided blood samples for vitamin and one carbon biochemistry analyses, an extensive analysis of >500 SNPs associated with one carbon metabolism and had eye examinations and ocular imaging. Data analysis are underway. The data collected to date have shown associations between one carbon pathway biochemistry and genetics and incidence of SANS. The mechanisms for SANS has yet to be identified, although many hypotheses exist. Based on our data, we have developed (8, 9) and expanded (6) a multi-hit hypothesis for how these seemingly disparate findings could be linked. While intriguing, the hypothesis represents the starting point for further research. We aim to clarify the relationship between B-vitamin status and genetics with regard to the risk of SANS. Ultimately, understanding the mechanism(s) behind this will provide a means to predict, prevent, or treat these ophthalmologic pathologies in astronauts, and terrestrial populations.

S M Smith↗
NASA NTRSDate not supplied

Oculometric Surveillance of Neuro-Ocular Function

Future missions to the moon or Mars will require the crew to monitor and assess their health and performance more autonomously, with approaches easily useable and interpretable by non-clinicians. If an autonomous oculometric diagnostic-support system proves to be a reliable predictor of impending impairment of visual function in the case of primary ocular pathology on Earth, then it could also be applied in the future to the surveillance of crew to detect the potential progression of sensorimotor and neuro-ocular compromises during extended spaceflight missions, e.g., SANS, and thus guide earlier and more effective countermeasure intervention. Towards that goal, we intend to determine if a set of largely independent eye-movement metrics, called oculometrics, measured using a simple voluntary eye-tracking task that can be completed in just 5 minutes per eye, could provide clinically valid biomarkers of functional visual deficits due to primary ocular pathology. The premise is that oculometrics could be used to monitor slowly evolving ocular pathologies, potentially detecting them even before structural evidence appears in ocular imaging or other current state-of-the-art clinical measures. This study investigates how NASA’s patented oculometric assessment of visual and visuomotor function, shown to correlate with performance in a manual control task, will correlate with standard ophthalmological tests to confirm clinical and thus operational, validity.

eye movements↗
NASA NTRSDate not supplied

Correlated Changes in Retinal Thickness and Visuomotor Function in Asymptomatic Plaquenil Toxicity Patients

We have previously shown that a 5-minute eye-movement test can capture a number of largely independent “oculometric” parameters of human visual/visuomotor function (Liston & Stone, 2014). This test has been successfully used to characterize mild neural impairment due to traumatic brain injury, sleep and circadian disruption, and alcohol consumption (Liston et al., 2017; Stone et al, 2019; Tyson et al, 2021). Here, we extend this approach to study patients at risk of progressive posterior-segment illness to see how oculometrics relate to standard clinical ophthalmological measures. Five female patients (<20:40 BCVA, 34-60 years old) undergoing hydroxychloroquine treatment (2-7mg/kg/day for 10-23 years for rheumatologic illness) have participated thus far. Under monocular viewing conditions in randomized order, they tracked a moving spot undergoing radial step-ramp motion in one of 90 randomized directions, at one of 5 randomized speeds, starting at random times (for details, see Stone et al, 2019). We computed nine independent oculometrics (latency, initial acceleration, steady-state gain, proportion smooth, saccadic rate, saccadic amplitude, direction noise, speed responsiveness, and speed noise). Spectral-domain optical coherence tomography (Zeiss, Dublin, CA) was used to measure the average thickness of the nine Early Treatment Diabetic Retinopathy Study macular sectors from the internal limiting membrane to the retinal pigmented epithelium. We used Pearson’s correlation between retinal thickness and our oculometrics with t-statistics to test separate one-sided hypotheses across 10 retinae. Our preliminary analysis found significant changes in several different aspects of visuomotor performance. Most notably, latency increased, initial acceleration decreased, and steady-state pursuit gain decreased as retinal thickness decreased (r2 = 0.364, 0.579, and 0.692; one-tailed P = 0.032, 0.005, and 0.001, respectively). Speed responsiveness appeared to decrease, but this effect was marginal for our current sample (r2 = 0.253, P = 0.069). Lastly, direction discrimination and saccadic behavior appeared unchanged. We conclude that oculometrics may provide sensitive measures of changes in retinal thickness. More importantly, oculometrics have the potential to detect impairment before it becomes evident with standard clinical imaging tools, while also providing insight into the behavioral implications of any resulting deficits in visual/visuomotor function.

eye movements↗
NASA NTRSDate not supplied

Spaceflight Associated Neuro-Ocular Syndrome: A Brief for Astronaut Candidates

INTRODUCTION: Spaceflight Associated Neuro-ocular Syndrome (SANS) was first described in 2011 as a clinical process involving degradation of visual acuity and structural changes of the eye when exposed to microgravity. This syndrome poses a risk to astronaut vision, safety, and mission performance, especially during extended-duration missions. The modern astronaut cohort is a diverse group of men and women including scientists, engineers, teachers, pilots, business professionals, and artists. Given their diverse backgrounds, it is imperative all crews are educated on SANS risks and potential countermeasures. This education must be comprehensive and easily understood, regardless of academic background or specific expertise. TOPIC: A PowerPoint was created to serve as a presentation and stand-alone educational aid for all astronaut candidates (ASCANS). This medium was chosen as it can be updated dynamically as new information emerges. The brief was split into sections to facilitate organized delivery of complex content in easy-to-understand components. Sections included descriptive statistics, signs and symptoms, outcomes, myths and ongoing research, countermeasures, ongoing surveillance, and unknown and future directions. More research is necessary in order to understand this syndrome, and without continued ASCAN participation in research, acquisition of data will not be possible. These efforts will become increasingly critical with deep space and exploration missions. APPLICATION: We recommend regular use of this brief for all ASCANS, and potentially veteran crewmembers, given the high risks and potentially poor outcomes associated with SANS. For ASCANS, recommendations include that this brief be provided at the start of their training, with a bi-annual refresher course for all astronauts. This ensures they are current on SANS information, given the dynamic nature of this syndrome. Additionally, this brief will be made available to all as a self-study aid, utilized as a refresher immediately prior to launch. It is anticipated that this brief will promote the health, safety, and wellbeing of professional and private crews alike, during and after long-duration spaceflight. RESOURCES: Brunstetter, T., Tarver, B., & Tsung, A. (2022, October). Spaceflight Associated Neuro-ocular Syndrome (Sans) and its Risk to Nasa Astronauts. JSC Aerospace Medicine Clerkship. Houston, TX; Lyndon B. Johnson Space Center. Laurie, S. S., Macias, B. R., Pardon, L. P., Brunstetter, T., Tarver, W. J., Gibson, C. R., Greenwald, S. H., Jasien, K. V., Mason, S., & Tsung, A. (2022). (rep.). Evidence Report: Risk of Spaceflight Associated Neuro-ocular Syndrome (SANS). Houston, TX: National Aeronautics and Space Administration. Mader, T. H., Gibson, C. R., Pass, A. F., Kramer, L. A., Lee, A. G., Fogarty, J., ... & Polk, J. D. (2011). Optic disc edema, globe flattening, choroidal folds, and hyperopic shifts observed in astronauts after long-duration space flight. Ophthalmology, 118(10), 2058-2069. LEARNING OBJECTIVES: • The audience will be able to describe current Spaceflight Associated Neuro-ocular Syndrome (SANS) findings, significance, and countermeasures. • The audience will understand the importance of astronauts’ familiarity with SANS prior to flying and the large risks associated with this syndrome. CME QUESTIONS (3 QUESTIONS, MULTIPLE CHOICE A-D): 1. What is the approximate prevalence rate of SANS in astronauts? A. 22% B. 50% C. 66% D. 80% Answer: C. 2. Which of the ocular findings are NOT associated with SANS? A. Optic disc edema B. Retinal detachment C. Globe flattening D. Chorioretinal folds Answer: B. 3. Which of the following diagnostic technologies are NOT available in-flight? A. Ocular ultrasound B. Retinal photography C. MRI Orbit D. Optical Coherence Tomography (OCT) Answer: C.

Sara Stroble Mason↗