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In\u2010flight, this can cause a change in the refraction of the eyes, requiring graded hypermetropic \u2018superfocus adjustable\u2019 glasses, optic nerve head oedema and choroidal folds. While the optic disc oedema resolves on returning to gravitational force, the choroidal folds and axial length shortening remain. Controversy remains over the role of intracranial pressure in the development of these changes. A recent case report has re\u2010energised the debate as to whether nutraceuticals and an individual's genetic expression of the 1\u2010carbon metabolic pathway are a major component for the development of this condition. The strict 6\u00b0\u00a0head down tilt bed rest platform remains the cornerstone for evaluating analogous pathological changes and trialling potential targeted therapies. The translational application of a glucagon\u2010like peptide 1 receptor agonist for the treatment of raised intracranial pressure in idiopathic intracranial hypertension may be of significance as a potential countermeasure for SANS. The aim of this narrative review is to explore the controversies in the integration of the presumed pathophysiological factors and to debate suitable countermeasures.<\/jats:p>","DOI":"10.1113\/ep091561","type":"journal-article","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T07:48:31Z","timestamp":1751528911000},"page":"4004-4014","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["An eye on long\u2010duration spaceflight: Controversies, countermeasures and challenges"],"prefix":"10.1113","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3733-6416","authenticated-orcid":false,"given":"Vincent Wing Sum","family":"Ng","sequence":"first","affiliation":[{"name":"Birmingham Neuro\u2010Ophthalmology University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6314-4437","authenticated-orcid":false,"given":"Susan Patricia","family":"Mollan","sequence":"additional","affiliation":[{"name":"Birmingham Neuro\u2010Ophthalmology University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"},{"name":"Department of Metabolism and Systems Science, School of Medical Sciences, College of Medical and Health University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,3]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000207866"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-014-2250-2"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-015-3189-6"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1905875"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1113\/EP092629"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3357\/ASEM.3674.2014"},{"issue":"9","key":"e_1_2_12_8_1","first-page":"4179","article-title":"Microgravity\u2010induced changes in skeletal muscle and possible countermeasures: What we can learn from bed rest and human space studies","volume":"111","author":"Bosutti A.","year":"2026","journal-title":"Experimental Physiology"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aan0972"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199805000-00029"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2024.2385"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00211.2023"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s002210100706"},{"key":"e_1_2_12_14_1","first-page":"92","article-title":"Artificial gravity as a countermeasure for mitigating physiological deconditioning during long\u2010duration space missions","volume":"9","author":"Cl\u00e9ment G. 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