Experiments on Visual Acuity and the Visibility of Markings on the Ground in Long-duration Earth-Orbital Space Flight
Visual acuity and visibility of markings on ground in long duration earth orbital space flight
Austin, R. W.↗
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Dynamic Visual Acuity: a Functionally Relevant Research Tool
Coordinated movements between the eyes and head are required to maintain a stable retinal image during head and body motion. The vestibulo-ocular reflex (VOR) plays a significant role in this gaze control system that functions well for most daily activities. However, certain environmental conditions or interruptions in normal VOR function can lead to inadequate ocular compensation, resulting in oscillopsia, or blurred vision. It is therefore possible to use acuity to determine when the environmental conditions, VOR function, or the combination of the two is not conductive for maintaining clear vision. Over several years we have designed and tested several tests of dynamic visual acuity (DVA). Early tests used the difference between standing and walking acuity to assess decrements in the gaze stabilization system after spaceflight. Supporting ground-based studies measured the responses from patients with bilateral vestibular dysfunction and explored the effects of visual target viewing distance and gait cycle events on walking acuity. Results from these studies show that DVA is affected by spaceflight, is degraded in patients with vestibular dysfunction, changes with target distance, and is not consistent across the gait cycle. We have recently expanded our research to include studies in which seated subjects are translated or rotated passively. Preliminary results from this work indicate that gaze stabilization ability may differ between similar active and passive conditions, may change with age, and can be affected by the location of the visual target with respect to the axis of motion. Use of DVA as a diagnostic tool is becoming more popular but the functional nature of the acuity outcome measure also makes it ideal for identifying conditions that could lead to degraded vision. By doing so, steps can be taken to alter the problematic environments to improve the man-machine interface and optimize performance.
Peters, Brian T.↗
Effects of Mild Hypercapnia During Head-Down Bed Rest on Ocular Structures, Cerebral Blood Flow, aud Visual Acuity in Healthy Human Subjects
The cephalad fluid shift induced by microgravity has been hypothesized to cause an elevation in intracranial pressure (ICP) and contribute to the development of the Visual Impairment/Intracranial Pressure (VIIP) syndrome, as experienced by some astronauts during long-duration space flight. Elevated ambient partial pressure of carbon dioxide (PCO2) on ISS may also raise ICP and contribute to VIIP development. We seek to determine if the combination of mild CO2 exposure, similar to that occurring on the International Space Station, with the cephalad fluid shift induced by head-down tilt, will induce ophthalmic and cerebral blood flow changes similar to those described in the VIIP syndrome. We hypothesize that mild hypercapnia in the head-down tilt position will increase choroidal blood volume and cerebral blood flow, raise intraocular pressure (IOP), and transiently reduce visual acuity as compared to the seated or the head-down tilt position without elevated CO2, respectively.
Laurie, S. S.↗
Stroboscopic Goggles as a Countermeasure for Dynamic Visual Acuity and Landing Sickness After Long-Duration Spaceflight
Gravity transitions cause changes in the vestibulo-occular reflex (VOR), which manifests as poor gaze control, a decrement in dynamic visual acuity (the ability to maintain gaze while in motion), both of which are caused by retinal slip. Retinal slip, the inability to keep an image focused on the retina, can drive or worsen sensory conflict, resulting in motion sickness (MS). Currently 100% of returning crewmembers report MS symptoms, which might affect their ability to perform mission critical tasks immediately after landing. Reschke et al. (2007) demonstrate that stroboscopic vision goggles improve motion sickness onset and symptom severity in motion sickness driven by retinal slip.
Rosenberg, M. J. F.↗
Sensitivity of The Dynamic Visual Acuity Test To Sensorimotor Change
Post-flight astronauts, acutely post-vestibular nerve section patients, and patients with severe chronic bilateral vestibular deficits have oscillopsia caused by reduced vestibulocular reflex gains and decreased postural stability. Therefore, as previous work has shown, a test of dynamic visual acuity (DVA), in which the subject must read numbers from a computer screen while standing still or walking in place provides a composite measure of sensorimotor integration. This measure may be useful for determining the level of recovery, post-flight, post-operatively, or after vestibular rehabilitation. To determine the sensitivity of DVA to change in impaired populations we have tested patients with acoustic neuromas before and during the first post-operative week after resection of the tumors, and with bilaterally labyrinthine deficient subjects before and after six weeks of balance rehabilitation therapy.
Cohen, Helen↗
Effect of Passive Horizontal Rotations and Vertical Oscillations on Dynamic Visual Acuity
Astronauts experience sensorimotor disturbances after long duration space flight. These crewmembers may need to egress the vehicle within a few minutes for safety and operational reasons in various sea state conditions following a water landing. Exposure to even low frequency motions induced by sea conditions surrounding a vessel can cause significant fine and gross motor control problems affecting critical functions. The objective of this study was to document human motor and visual performance during simulated wave motion in the 0.1 to 2.0 Hz range. We examined in 12 healthy subjects the changes in accuracy when performing a seated visual target acquisition task in which the location of target was offset vertically during horizontal full body rotation at an oscillating frequency of 0.8 Hz (peak velocity of 160 deg/s). The main finding was that the accuracy of performance degraded in 7 of 12 subjects when acquiring vertical targets at perturbing frequencies of 0.8 Hz in the horizontal plane by one step size. We also examined in a separate study on 12 healthy subjects seated dynamic visual acuity (DVA) task performance during vertical full body oscillations at perturbing frequencies of 2 Hz (peak to peak motion of 5 cm). The main finding was that DVA was significantly reduced when acquiring targets at perturbing oscillations at frequencies of 2 Hz in the vertical plane by approximately 1 chart line. Thus low frequencies of perturbations in the horizontal and vertical planes can cause decrement in visual performance.
Mulavara, Ajitkumar↗
Experiment S-8/D-13, Visual Acuity and Astronaut Visibility
Preflight, inflight, and postflight tests of visual acvity of Gemini V and VII crew members
VISUAL ACUITY↗
Evaluation of visual acuity with Gen 3 night vision goggles
Using laboratory simulations, visual performance was measured at luminance and night vision imaging system (NVIS) radiance levels typically encountered in the natural nocturnal environment. Comparisons were made between visual performance with unaided vision and that observed with subjects using image intensification. An Amplified Night Vision Imaging System (ANVIS6) binocular image intensifier was used. Light levels available in the experiments (using video display technology and filters) were matched to those of reflecting objects illuminated by representative night-sky conditions (e.g., full moon, starlight). Results show that as expected, the precipitous decline in foveal acuity experienced with decreasing mesopic luminance levels is effectively shifted to much lower light levels by use of an image intensification system. The benefits of intensification are most pronounced foveally, but still observable at 20 deg eccentricity. Binocularity provides a small improvement in visual acuity under both intensified and unintensified conditions.
Bradley, Arthur↗
A Data Mining Project to Identify Cardiovascular Related Factors That May Contribute to Changes in Visual Acuity Within the US Astronaut Corps
Many of the cardiovascular-related adaptations that occur in the microgravity environment are due, in part, to a well-characterized cephalad-fluid shift that is evidenced by facial edema and decreased lower limb circumference. It is believed that most of these alterations occur as a compensatory response necessary to maintain a "normal" blood pressure and cardiac output while in space. However, data from both flight and analog research suggest that in some instances these microgravity-induced alterations may contribute to cardiovascular-related pathologies. Most concerning is the potential relation between the vision disturbances experienced by some long duration crewmembers and changes in cerebral blood flow and intra-ocular pressure. The purpose of this project was to identify cardiovascular measures that may potentially distinguish individuals at risk for visual disturbances after long duration space flight. Toward this goal, we constructed a dataset from Medical Operation tilt/stand test evaluations pre- (days L-15-L-5) and immediate post-flight (day R+0) on 20 (3 females, 17 males). We restricted our evaluation to only crewmembers who participated in both shuttle and space station missions. Data analysis was performed using both descriptive and analytical methods (Stata 11.2, College Station, TX) and are presented as means +/- 95% CI. Crewmembers averaged 5207 (3447 - 8934) flight hours across both long (MIR-23 through Expedition16) and short (STS-27 through STS-101) duration missions between 1988 and 2008. The mean age of the crew at the time of their most recent shuttle flight was 41 (34-44) compared to 47 (40-54) years during their time on station. In order to focus our analysis (we did not have codes to separate out subjects by symptomotology) , we performed a visual inspection of each cardiovascular measures captured during testing and plotted them against stand time, pre- to post-flight, and between mission duration. It was found that pulse pressure most clearly differentiated the two mission types. Statistical analysis confirmed that pulse pressure was significantly higher before [45.6; (42.1 to 49.1)] and after [50.7; (46.9 to 54.6)] time on station compared with their most recent shuttle flight [31.6 (27.8 to 35.4), and 32.2 (28.3 to 36.0) respectively] even after correcting differences in age and cumulative number of mission hours. Without knowing the identity of which long duration crewmembers demonstrated visual changes, we were limited to examining whether certain crew regulate components of pulse pressure, systolic and diastolic blood pressure, differently due to microgravity exposure. To that end, we stratified crew into tertiles based on either their pre-flight measure of systolic or diastolic blood pressure. Those crew in the highest tertile for both systolic (lower tertile (n=8; 103-111), middle tertile (n=7; 113-121), and upper tertile (n=5; 125-136) and diastolic blood pressure (lower tertile (n=8; 58-64), middle tertile (n=7; 67-73), and upper tertile (n=5; 75-81) demonstrated less variability in pulse pressure between R+0 and L-10 (Figure 2). Interestingly, those crewmembers with the highest resting systolic blood pressure demonstrated either no change or in some instances an increase in total peripheral resistance, where those in the lower tertiles had lower values of total peripheral resistance compared to pre-flight levels. In this study, it was found that crewmembers in the highest tertile for both systolic and diastolic blood pressure demonstrated less variability in pulse pressure and that the decrease in variability was due in part to lower levels of compliance as indicated by similar or higher levels of total peripheral resistance after compared with before flight levels. Whether there is a relation between blood pressure regulation and total peripheral resistance in crew presenting with negative changes in visual acuity remains unknown.
Westby, Christian M.↗
Effect of 1% Inspired CO2 During Head-Down Tilt on Ocular Structures, Cerebral Blood Flow, and Visual Acuity in Healthy Human Subjects
The cephalad fluid shift induced by microgravity has been hypothesized to elevate intracranial pressure (ICP) and contribute to the development of the visual impairment/intracranial pressure (VIIP) syndrome experienced by many astronauts during and after long-duration space flight. In addition, elevated ambient partial pressure of carbon dioxide (PCO2) on the International Space Station (ISS) has also been hypothesized to contribute to the development of VIIP. We seek to determine if an acute, mild CO2 exposure, similar to that occurring on the ISS, combined with the cephalad fluid shift induced by head-down tilt will induce ophthalmic and ICP changes consistent with the VIIP syndrome.
Laurie, S. S.↗
Validity and Reliability of Dynamic Visual Acuity (DVA) Measurement During Walking
DVA is primarily subserved by the vestibulo‐ocular reflex mechanism. Individuals with vestibular hypofunction commonly experience highly debilitating illusory movement or blurring of visual images during daily activities possibly, due to impaired DVA. Even without pathologies, gradual age‐related morphological deterioration is evident in all components of the vestibular system. We examined the construct validity to detect age‐related differences and test‐retest reliability of DVA measurements performed during walking. METHODS: Healthy adults were recruited into 3 groups: 1. young (20‐39years, n=18), 2. middle‐aged (40‐59years, n=14), and 3. older adults (60‐80years, n=15). Randomly selected seven participants from each group (n=21) participated in retesting. Participants were excluded if they had a history of vestibular or neuromuscular pathologies, dizziness/vertigo or >1 falls in the past year. Older persons with MMSE scores <29/30 were excluded to minimize cognitive errors. Participants' age, height, weight and normal walking speed were recorded. The binocular DVA was measured while walking on a treadmill at 0.8 m/s, 1.0 m/s and 1.2 m/s speeds. The walking speeds chosen represent a range of slow to moderate walking speeds for adult life span in participants who have no current mobility problems. The monitor that displayed Landolt 'C' optotypes was placed at 50 cm from the eyes for nearDVA (primary compensation by otolith organs) and at 3.0 m for farDVA (primary compensation by semicircular canals). A mixed factor ANOVA (age group x speed) was performed separately for the Near and FarDVA for detecting group differences. Intraclass correlation coefficients (ICCs) were calculated for each condition to determine test‐retest reliability. RESULTS: The three age groups were not different in their height, weight and normal walking speed (p>0.05). The post hoc analyses for DVA measurements demonstrated that each group was significantly different from the other two groups for Near as well as FarDVA (p<0.001‐p=0.031). The effect of speed was significant for both NearDVA (p=0.012) and FarDVA (p=0.014), however, there was no age group x speed interaction (FarDVA p=0.607, NearDVA p=0.343). The ICCs for Near and FarDVA ranged between 0.85‐ 0.88 and 0.71‐0.87, respectively. CONCLUSIONS: Differences in DVA between the three age groups were detected by using both Near and FarDVA protocols irrespective of the walking speed. Therefore, age group‐specific reference values should be used for detecting malfunction. Further, consistency in walking speed is critical for comparing between studies. NearDVA at all walking speeds and FarDVA at the speed of 1.2 m/s demonstrated excellent testretest reliability. FarDVA at 0.8 m/s and 1.0 m/s demonstrated good test‐retest reliability (ICCs 0.71 and 0.77, respectively).
Deshpande, Nandini↗
Visual Acuity During Treadmill Walking
An awareness of the physical world is essential for successful navigation through the environment. Vision is the means by which this awareness is made possible for most people. However, without adequate compensation, the movements of the body during walking could impair vision. Previous research has shown how the eyes, head and trunk movements are coordinated to provide the compensation necessary for clear vision, but the overall effectiveness of these coordinated movements is unknown. The goal of the research presented here was to provide a direct measure of visual performance during locomotion, while also investigating the degree to which coordinated head and body movements can be altered to facilitate the goal of seeing clearly.
Peters, B. T.↗
FAR and NEAR Target Dynamic Visual Acuity: A Functional Assessment of Canal and Otolith Performance
Upon their return to earth, astronauts experience the effects of vestibular adaptation to microgravity. The postflight changes in vestibular information processing can affect postural and locomotor stability and may lead to oscillopsia during activities of daily living. However, it is likely that time spent in microgravity affects canal and otolith function differently. As a result, the isolated rotational stimuli used in traditional tests of canal function may fail to identify vestibular deficits after spaceflight. Also, the functional consequences of deficits that are identified often remain unknown. In a gaze control task, the relative contributions of the canal and otolith organs are modulated with viewing distance. The ability to stabilize gaze during a perturbation, on visual targets placed at different distances from the head may therefore provide independent insight into the function of this systems. Our goal was to develop a functional measure of gaze control that can also offer independent information about the function of the canal and otolith organs.
Peters, Brian T.↗
Validation of a Manually Oscillating Chair for In-The-Field Assessment of Dynamic Visual Acuity on Crewmembers Within Hours of Returning from Long-Duration Spaceflight
Due to the deconditioned state of crewmembers in the initial hours after landing, it is safer and more practical to perform a vision test while seated in a chair versus walking on a treadmill. The purpose of this study was to validate the ability of a manually operated oscillating chair to produce the oscillatory frequency and displacement equivalent of walking on a treadmill at a 4 mph pace. A fast Fourier transform (FFT)was performed on the vertical trunk acceleration to compare the peak and spread of the distribution of oscillation frequencies for each oscillating condition. Peak oscillation frequencies achieved with the manual chair were lower and more variable than those of treadmill walking and the automatic chair. This can mostly be attributed to operator fatigue. However, DVA scores across conditions were not significantly different, indicating that the manual chair can provide adequate vertical oscillation frequency and displacement with the added advantage of being portable enough for testing outside a laboratory. Furthermore the automatic chair very closely matches the oscillation frequency of treadmill walking, making it an ideal method for testing DVA in a laboratory setting.
Kreutzberg, G. A.↗
Relating Standardized Visual Perception Measures to Simulator Visual System Performance
Human vision is quantified through the use of standardized clinical vision measurements. These measurements typically include visual acuity (near and far), contrast sensitivity, color vision, stereopsis (a.k.a. stereo acuity), and visual field periphery. Simulator visual system performance is specified in terms such as brightness, contrast, color depth, color gamut, gamma, resolution, and field-of-view. How do these simulator performance characteristics relate to the perceptual experience of the pilot in the simulator? In this paper, visual acuity and contrast sensitivity will be related to simulator visual system resolution, contrast, and dynamic range; similarly, color vision will be related to color depth/color gamut. Finally, we will consider how some characteristics of human vision not typically included in current clinical assessments could be used to better inform simulator requirements (e.g., relating dynamic characteristics of human vision to update rate and other temporal display characteristics).
Kaiser, Mary K.↗
Visual Impairment and Intracranial Hypertension: An Emerging Spaceflight Risk
During recent long duration missions to the International Space Station (ISS) crewmembers have reported changes in visual acuity or visual field defects. Exams in the postflight period revealed changes to the visual system and elevated intracranial pressures. As a result, NASA Space Medicine has added a number of tests to be performed in the preflight, inflight and postflight periods for ISS and shuttle missions with the goal of determining the processes at work and any potential mitigation strategies. This discussion will acquaint you with the changes that NASA has made to its medical requirements in order to address the microgravity induced intracranial hypertension and associated visual changes. Key personnel have been assembled to provide you information on this topic. Educational Objectives: Provide an overview of the current Medical Operations requirements and the mitigation steps taken to operationally address the issue.
Taddeo, Terrance A.↗
Are Medications Involved in Vision and Intracrancial Pressure Changes Seen in Spaceflight?
The Food and Drug Association Adverse Event Reports (FDA AER) from 2009-2011 were used to create a database from millions of known and suspected medication-related adverse events among the general public. Vision changes, sometimes associated with intracranial pressure changes (VIIP), have been noted in some long duration crewmembers. Changes in vision and blood pressure (which can subsequently affect intracranial pressure) are fairly common side effects of medications. The purpose of this study was to explore the possibility of medication involvement in crew VIIP symptoms. Reports of suspected medication-related adverse events may be filed with the Food and Drug Administration (FDA) by medical professionals or consumers. Quarterly compilations of these reports are available for public download. Adverse Event Reporting System (AERS) reports from 1/1/2009- 6/30/2012 were downloaded and compiled into a searchable database for this study. Reports involving individuals under the age of 18 and older than 65 were excluded from this analysis. Case reports involving chronic diseases such as cancer, diabetes, multiple sclerosis and other serious conditions were also excluded. A scan of the medical literature for medication-related VIIP-like adverse events was used to create a list of suspect medications. These medications, as well as certain medications used frequently by ISS crew, were used to query the database. Queries for use of suspected medications were run, and the nature of the symptoms reported in those cases were tabulated. Symptoms searched in the FDA AERS were chosen to include the typical symptoms noted in crewmembers with VIIP. Vision symptoms searched were: visual acuity reduced, visual impairment, and vitreous floaters. Pressure changes included: abnormal sensation in eye, intracranial pressure increased, intraocular pressure increased, optic neuritis, optic neuropathy, and papilloedema. Limited demographic information is included with the FDA AERS; relevant data were also sorted by age and sex from each report. RESULTS Steroid-containing oral contraceptives had the highest number of reports associated with vision (n=166) and pressure symptoms (n=54). Corticosteroid-containing medications were also high; prednisone, for example, had 137 reports of vision issues and 79 of pressure issues. Pain relievers were also a medication class with vision and pressure-related adverse events reported. Common over-the-counter medications such as acetaminophen, aspirin and ibuprofen each had multiple reports for both vision and pressure symptoms. Antimicrobial medications ciprofloxacin and diflucan were also associated with a number of vision and pressure-related AERS. Unexpectedly, pseudoephedrine and promethazine were mentioned in fewer than 20 reports each over the 3.5 years of data examined. The FDA AERS represents a wealth of data, but there are several limitations to its use. The data are entered by the public or medical professionals, but are not checked for accuracy or completeness and may even be entered multiple times. The causal relationship between a particular adverse event and a particular medication is not tested. The cases represent a broad spectrum of demographics, occupations, and health histories, and thus do not model the astronaut population well. There is no information on the frequency of use of a medication for comparison purposes; it is not possible to assign a rate for any particular adverse event. Nonetheless, there are compelling trends. Use of corticosteroid-containing medications, pain relievers (even over-the-counter), and oral contraceptives were associated with higher numbers of vision- or intracranial pressure-related adverse events. In general, there were more vision problems than pressure problems reported. Certain medications that were once suspected of playing a role in the crew VIIP syndrome, namely pseudoephedrine and promethazine, were found to have extremely low numbers of VIIP-like AERS in the FDA data. However, crew use of corticosteroid-containing medications and pain relievers may warrant additional investigation
Faust, K. M.↗