The case for anterior segment optical coherence tomography (AS-OCT) for the international space station and future planetary spaceflight: Clinical relevance and technical implementation

Spaceflight presents unique challenges to ocular health which must be addressed when considering future long-term missions to Mars and beyond, specifically with increased risk to the anterior segment of the eye. While the posterior segment has been heavily researched via examinations with Heidelberg's Spectralis Optical Coherence Tomography (OCT)2 Module aboard the International Space Station (ISS), evaluation of the anterior segment is not as extensively performed. Despite the capabilities of the Spectralis, which allows for anterior segment imaging via the Anterior Segment Module (ASM), transforming the OCT into an Anterior Segment OCT (AS-OCT), there is limited information available regarding anterior segment effects due to microgravity and spaceflight. Imaging of the anterior segment allows for high resolution details of structures such as the cornea, anterior chamber angles and depth, iris, and lens that may all become affected due to the unique environment astronauts are exposed to during spaceflight. We advocate for the routine use of AS-OCT in ocular examinations aboard the ISS and during spaceflight, offering valuable insight into ocular changes that occur and to help guide management for various anterior segment pathologies one may face, ultimately benefitting both current and future efforts for space travel.