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.

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.

To report the course of atypical choroidal neovascularization (CNV) in a middle-aged woman experiencing sudden vision loss. A middle-aged female presented with sudden onset vision loss. Following in depth investigations an initial diagnosis of presumed idiopathic CNV was made in her right eye. Multimodal imaging confirmed the presence of CNV, while the left eye remained unaffected. The CNV initially responded well to intravitreal Aflibercept injections, resulting in significant visual improvement. However, the patient later developed punctate inner choroidopathy (PIC), which eventually responded to systemic but not local corticosteroids. Recurrent CNV became incompletely controlled by Aflibercept. Switching to Faricimab resulted in sustained visual acuity improvement and CNV resolution. The therapeutic efficacy of anti-VEGF treatments has long been underscored in the management of CNV. However, CNV in younger patients often points to a different causation and sometimes requires different management. Our case underscores the significance of inflammatory causes of CNV and including anti-inflammatories in the treatment of CNV management and outlines differences in anti-VEGF efficacy in control of CNV.

This study aimed to develop and validate the University of California Irvine Corneal Cystine Crystal Score (UCI CCCS), a novel grading system for objectively assessing corneal crystal deposition in cystinosis patients using a slit lamp biomicroscope. This tool provides a standardized method for monitoring disease progression and evaluating treatment efficacy. This retrospective study analyzed clinical records from 36 cystinosis patients examined at the Day of Hope conference, all with the infantile nephropathic form. The records included evaluations from slit-lamp examinations and Best Corrected Visual Acuity (BCVA). After evaluation, the UCI CCCS was developed by experts in pediatric ophthalmology and cornea specialty; this system differentiates cystine crystal density, iris visibility, and corneal haze on a scale from 0 to 5. For validation, 107 slit-lamp images were assessed by masked graders. Statistical analysis using Intraclass Correlation Coefficient (ICC) and Cohen’s kappa was performed to confirm the tool’s ability to produce consistent, reproducible results across and within graders. The cohort included 23 males and 13 females (mean age: 15.64 years, range: 0–60). A total of 72 eyes were evaluated. In the validation phase, the UCI CCCS demonstrated high inter-rater agreement (κ = 0.869, P < 0.001) and excellent intra-rater reliability (ICC = 0.922, P < 0.001). The UCI CCCS is a validated, reliable, and reproducible tool for assessing corneal crystal involvement in cystinosis, supporting its clinical and research applications.

Neural vision restoration is a rapidly advancing discipline at the intersection of neuroscience, bioengineering, and ophthalmology. This review synthesizes emerging strategies to restore visual perception through retinal prostheses, optic nerve and thalamic implants, cortical brain-computer interfaces (BCIs), optogenetics, and non-invasive stimulation. Although initial experiments have demonstrated primitive visual abilities such as light perception and motion detection, artificial vision remains cognitively demanding and fundamentally different from natural vision. Advances in artificial intelligence and machine learning may enable adaptive, closed-loop systems that optimize stimulation, enhance low-light vision, and integrate environmental inputs for more intelligible percepts. At the same time, a growing understanding of neural plasticity, cortical remapping, and perceptual learning highlights the need for multidisciplinary strategies in visual rehabilitation. Ethical and regulatory concerns, including informed consent, data protection, neural enhancement, and equitable access, remain central to responsible implementation. The potential of BCIs to bypass the eye entirely, and of neuroprosthetics to be used in spaceflight, disaster response, or military medicine, expands the applications of vision restoration beyond blindness alone. Bridging technological, clinical, and ethical strategies in this review outlines the challenges and opportunities that define the future of neural ophthalmology. Ultimately, restoring sight will require not only functioning hardware, but systems compatible with the reorganized brain and the lived experience of visual loss.