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  • Choroidal Changes During Spaceflight

    By Jean Shaw
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, February 2023

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    Ferguson et al. aimed to objectively document and quantify the prevalence and progression of choroidal folds, retinal folds, and peripapillary wrinkles in crew members flying long-duration missions to the International Space Sta­tion (ISS). They found that choroidal folds were the most common fold type to develop.

    For this retrospective cohort study, the researchers obtained OCT scans of 36 crew members (72 eyes). The partic­ipants’ mean age was 46 years, and they had taken part in space missions with a mean duration of 189 days onboard the ISS. The OCT scans were taken before, during, and after spaceflight. A panel of experts examined the scans for the presence of chorioretinal folds. Optic disc edema was identified via calculat­ing peripapillary total retinal thickness, and choroidal folds were quantified based on surface roughness within macular and peripapillary regions of interest. The main outcome measures included fold incidence, peripapillary total retinal thickness, and Bruch mem­brane surface roughness.

    Of the 36 crew members, six (12 eyes) demonstrated at least one type of fold during spaceflight. All 12 eyes had bilateral choroidal folds; two had both choroidal and inner retinal folds, and two had choroidal folds, inner retinal folds, and peripapillary wrinkles. Optic disc edema was observed in 25 of the 36 crew members (42 of 72 eyes). Of these, two eyes also had peripapillary wrinkles, four had inner retinal folds, and 10 had choroidal folds.

    Of note, macular and peripapillary choroidal folds developed as early as flight day 26 and as late as flight day 266 and continued to worsen through­out mission duration. In four crew members (six eyes), the macular folds extended into the fovea. Fortunately, each of these four astronauts demon­strated a BCVA of 20/15 or better with normal visual fields and Amsler grid findings within four days after return­ing from their missions. Even so, as the authors pointed out, “disruption of the foveal photoreceptor layer could pose a vision concern for future extended-duration missions.” (Also see related commentary by Prem S. Subramanian, MD, PhD, in the same issue.)

    The original article can be found here.