Human space exploration presents an unparalleled opportunity to study life in extreme environments—but it also exposes astronauts to physiological stressors that jeopardize key systems like vision. Corneal health, essential for maintaining precise visual acuity, is threatened by microgravity-induced fluid shifts, cosmic radiation, and the confined nature of spacecraft living environments. These conditions elevate the risk of corneal abrasions, infections, and structural damage. In addition, Spaceflight-Associated Neuro-Ocular Syndrome (SANS)—while primarily affecting the posterior segment—has also been potentially linked to anterior segment alterations such as corneal edema and tear film instability. This review examines these ocular challenges and assesses current mitigation strategies. Traditional approaches, such as terrestrial eye banking and corneal transplantation, are impractical for spaceflight due to the limited viability of preserved tissues, surgical complexities, anesthetic risks, infection potential, and logistical constraints. The paper explores emerging technologies like 3D bioprinting and stem cell-based tissue engineering, which offer promising solutions by enabling the on-demand production of personalized corneal constructs. Complementary advancements, including adaptive protective eyewear, bioengineered tear substitutes, telemedicine, and AI-driven diagnostic tools, also show potential in autonomously managing ocular health during long-duration missions. By addressing the complex interplay of environmental stressors and biological vulnerabilities, these innovations not only safeguard astronaut vision and mission performance but also catalyze new pathways for regenerative medicine on Earth. The evolution of space-based ophthalmic care underscores the dual impact of space medicine investments across planetary exploration and terrestrial health systems.

Long-term spaceflight induces multisystem stress, including cardiovascular deconditioning, skeletal muscle atrophy, immune suppression, and neuro-ocular syndromes. Current countermeasures reduce symptoms but cannot replicate the synergistic resilience needed for extended missions or critical illness. Hibernating animals, specifically brown bears (Ursus arctos), survive prolonged immobility, starvation, and bradycardia without resultant pathology. This review incorporates adaptations observed in bears and certain torpid species, including reversible insulin resistance, suppression of muscle atrophy genes MuRF1 and Atrogin-1, and maintenance of the heart despite seasonal production decline. The thirteen-lined ground squirrels (Ictidomys tridecemlineatus) maintain retinal structure and synaptic stability throughout torpor, avoiding neuro-ocular complications despite prolonged inactivity. Mechanisms span from RBM3-dependent synaptic maintenance, titin isoform remodeling under the control of RBM20, mTOR and FOXO pathway regulation, remodeled hydrogen sulfide metabolism, and microbiome-mediated nitrogen salvage. These adaptations are different from human adaptation to microgravity and disuse and offer translational candidates for synthetic torpor, probiotic engineering, neuroprotection, and protein-sparing therapy. Hibernators are not passive stress subjects; they perform coordinated anticipatory responses in multiple organs. Comparing these systems in large and small hibernators, we aim to uncover a biologically realistic path to human resilience. These findings guide a shift from reactive, pharmacological measures for preserving human health during space flight, intensive care, and extreme environments towards proactive, biologically initiated measures.

Spaceflight-associated dry eye syndrome (SADES) has been reported among astronauts during both International Space Station (ISS) and Space Transportation System (STS) missions. As future missions extend beyond low Earth orbit, the physiological challenges of spaceflight include microgravity, radiation, and environmental stressors, which may further exacerbate the development of ocular surface disease. A deeper understanding of the underlying pathophysiology, along with the exploration of innovative countermeasures, is critical. In this review, we examine nanomedicine as a promising countermeasure for managing ophthalmic conditions in space, with the goal of enhancing visual health and mission readiness for long-duration exploration-class missions.

Objective: To characterize national patterns of ocular trauma related to pickleball, dodgeball, and kickball in the United States, with emphasis on incidence, demographics, injury mechanisms, and diagnoses. Methods: Data from the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (2014–2023) were reviewed. Injury cases were identified using body part codes for the eye, face, and head combined with product code 3235 (“Other Ball Sports”). Trauma narratives were subsequently manually reviewed to confirm sport involvement alongside ocular and/or orbital injury. National injury estimates were calculated using the NEISS-provided sample weights. Annual incidence per million people was calculated using data from the U.S. Census Bureau and American Community Survey. Statistical analyses included descriptive statistics and inferential testing using chi-square tests, ANOVA, and linear regression. Results: A total of 120 confirmed cases were identified, corresponding to an estimated 7974 ocular injuries (95% CI: 7184–8764). Weighted estimates attributed 3874 cases (95% CI: 3429–4319) to dodgeball, 2573 (95% CI: 2218–2928) to pickleball, and 1527 (95% CI: 1255–1799) to kickball. Pickleball injuries primarily affected older adults (mean age 58.27 years), whereas dodgeball and kickball injuries occurred mostly in youth (mean ages 13.32 and 14.88 years). Direct ball impact was the leading mechanism, with corneal abrasion as the most frequent diagnosis. Falls (15.38%) and orbital fractures (11.54%) were more common with pickleball. Linear regression demonstrated a significant increase in pickleball-related ocular trauma from 2014 to 2023 ( P = 0.04). Conclusions: Pickleball-related ocular trauma is increasing nationally, particularly among older adults. These largely preventable injuries highlight the need for sport-specific preventive strategies and increased access to protective eyewear.

Introduction: Socio-economic status (SES) influences paediatric visual health by affecting eye care access, refractive error prevalence and spectacle provision. This study examines the link between household income and paediatric vision outcomes in Orange County, California, USA using data from the University of California, Irvine EyeMobile Pediatric Clinic (2021–2024). Methods: Vision screening was conducted on 15 842 children (ages 3–10). Subsequent comprehensive eye examinations were performed on 3350 children who failed initial screening. Socio-economic stratification was based on zip-code-level median household income (MHI), categorised as below-average or above-average for Orange County. A retrospective cross-sectional analysis of examination data compared visual acuity, refractive error and spectacle provision rates between the two SES groups. Results: Children from below-average MHI areas had higher screening failure rates than those from above-average MHI areas (24.6% vs 18.5%) and a higher odds of screening failure (OR 1.44, 95% CI 1.33 to 1.57). They also demonstrated a higher need for spectacles (70.3% vs 64.8%), with an increased odds of requiring spectacles (OR 1.28, 95% CI 1.05 to 1.56). The prevalence of astigmatism was higher among children from areas with below-average MHI (75.3% vs 66.1%), corresponding to a significantly higher odds of astigmatism (OR 1.56, 95% CI 1.36 to 1.79). Best-corrected distance visual acuity improved with the provision of spectacles in both income groups; however, children from lower-income communities were more likely to present with uncorrected visual impairment during screening, consistent with the higher screening failure rates observed. Conclusion: Children from lower-income communities demonstrated higher rates of uncorrected visual impairment and a greater need for vision care services, while children from higher-income communities also faced substantial unmet vision needs. A mobile school-based vision screening programme, such as the EyeMobile, could significantly benefit both groups by promoting equitable access to vision care.