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SANS is caused by exposure to prolonged microgravity and at least one feature of SANS has been reported in 81% of National Aeronautics and Space Administration (NASA) astronauts. Early clinical features of SANS are observed in almost all individuals undergoing spaceflight, with the condition exacerbated by the duration of spaceflight. Knowledge of the features of SANS and the aetiology has rapidly grown since its first description in 2011. As international space agencies plan exploration beyond low Earth orbit and with the expansion of the commercial space sector, a publicly available consensus guide on diagnosis and potential management would be instructive to flight surgeons who manage SANS. Harmonising case identification will not only enhance clinical management but is also vital to set a framework for research into SANS. Here we collate and interpret the up-to-date phenotyping and clinical insight in SANS, with expertise from the leading SANS experts at NASA. A consensus on diagnosis and management with countermeasures is detailed. Space exploration is a rapidly evolving field and consequently, insights into SANS will undoubtedly grow and allow us to further refine our understanding of this condition.<\/jats:p>","DOI":"10.1038\/s41433-026-04651-6","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T08:46:43Z","timestamp":1782809203000},"page":"1794-1805","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Spaceflight-associated neuro-ocular syndrome (SANS): expert consensus on diagnosis and management"],"prefix":"10.1038","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7816-4927","authenticated-orcid":false,"given":"Jessie","family":"Gew","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousef F.","family":"Hyder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5560-802X","authenticated-orcid":false,"given":"Olivia","family":"Grech","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyson","family":"Brunstetter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Tarver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara S.","family":"Mason","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9422-3130","authenticated-orcid":false,"given":"C. 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Yousef Hyder reports no conflicts. Olivia Grech reports consultancy fees (Invex Therapeutics). Tyson Brunstetter reports no conflicts. William Tarver reports no conflicts. Sara Mason reports no conflicts. Robert Gibson reports no conflicts. James D Polk reports no conflicts. Victor Schneider reports no conflicts. Mary Van Baalen reports no conflicts. James Mitchell is employed by the Ministry of Defense, UK. Andreas Yiangou reports speaker fees from Teva UK. Susan Mollan reports consultancy fees (Invex Therapeutics); advisory board fees (Ocular Therapeutix, Domp\u00e9); speaker fees (Teva, AbbVie); Travel (AbbVie, EssilorLuxottica, European Alliance of Associations for Rheumatology); Receipt of equipment (Heidelberg Engineering). Susan Mollan is a member of the Eye editorial board. Alexandra Sinclair reports she has consulted for Novartis, AbbVie, Vertex and Orion Pharma and speaker fees from Teva UK and Novartis on unrelated topics.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}}]}}