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>> Brandi Dean: Good morning.

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Welcome to Mission
Control Houston.

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As I promised, we have here
with us Dr. Christian Otto,

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who is the principal
investigator

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for the ocular health experiment

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which flight engineers
Rick Mastracchio and...

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is helping Mike Hopkins
with today.

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And he's going to
tell us a little bit

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about what's been going
on with that experiment,

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what it's about, and what some

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of the results they've
started seeing are.

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Thanks so much for joining us.

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>> Dr. Christian Otto:
Yeah, thanks, Brandi.

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As you may know,
as you may know,

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the ocular health
experiment was instituted

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because of the eye problems
that were documented

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in a number of crew members.

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As you may know,
up to 50 percent

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of crew members have changes

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in their vision following
their space flight.

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And in 2005 we found a
rather concerning eye problem

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which is swelling of the back

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of the optic nerve
as it enters the eye.

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And this is actually
quite a serious problem.

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In fact, we see it
in many diseases

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such as glaucoma
and head trauma.

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It can be a sign of elevated
intracranial pressure,

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and if this does not resolve it
can actually lead to blindness.

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And after some investigation,

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there's actually been
six crew members now

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who developed this
serious finding,

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but there have been
other findings, as well,

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such as changes in the
structure of the eyeball itself,

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it's been somewhat compressed
in many crew members,

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and also widening
of the covering

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of the optic nerve
behind the eye.

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Both of these findings
are actually suggestive

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of elevated intracranial
pressure.

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So this is of concern to
the program, particularly

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with future longer-duration
missions.

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>> Brandi Dean: That
makes sense.

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Do you have any theories
about what's causing it

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or why we're seeing that?

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>> Dr. Christian Otto: Yeah,
that's a very good question

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and one of the leading
hypotheses is the cephalad

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fluid shift.

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So this is -- here on earth,
we have gravity acting

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on our fluids; fluid is
drawn toward the lower part

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of the body.

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But in space flight, it actually
gravitates more toward the head,

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as you see here in the
video that we're showing.

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You can see that fluid tends to
move upwards in weightlessness,

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and one of our concerns
is that this may lead

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to elevated intracranial
pressure.

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And you can see that fluid

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around the brain actually
communicates with the back

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of the eye through,
around the optic nerve,

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which is also surrounded
by the sheath,

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and you can see this
with the blue arrows.

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And if the pressure increases,
it can actually widen the back

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of the optic nerve sheath
and push on the eyeball.

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And this is why we
see this compression

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of the eye, as you can see here.

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And these pressure differentials
can cause changes in vision.

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And we can measure vision by
refractive change or diopters.

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This has to do with the
optical power of the eye.

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And these changes result in
a degradation of near vision.

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>> Brandi Dean: Okay, so
that's what we think is kind

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of causing it, I guess.

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What is the crew member, what
are the crew members doing

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on board the Space Station to
help get us more information?

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>> Dr. Christian Otto: Yeah,

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so as part of the ocular health
experiment, we have a number

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of tests that we're conducting.

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This is also part of the medical
ops data collection, as well.

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But things you might get done
in your family doctor's office

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or if you go to the
optometrist or ophthalmologist.

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We're doing fundoscopy.

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Fundoscopy ops are going
on today, I believe,

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in Mike Hopkins and
Koichi Wakata,

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where we're taking pictures
of the back of the eye.

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This is as though you were
at the doctor's office

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and they're looking at
the back of your eye

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with an ophthalmoscope, but
this has a much more higher

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resolution and we can look
at the vessels of the eye,

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the retina and the optic nerve.

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We're also doing
ocular ultrasound.

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This allows us to look at
the structures of the back

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of the eye, measure
that compression

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if it's occurring,
and the widening.

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And there's a new device

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on station now called
ocular coherence tomography.

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It's a very powerful ultrasound
device that lets us look

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in very fine detail at the
retina and the optic nerve

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to see swelling long
before we can see it

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with an ophthalmoscope.

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So this allows us to more
carefully monitor crew members,

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whether they're headed
toward these findings.

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We're also measuring
intraocular pressure,

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so taking a pen-like device
and this taps on the eye

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and we can measure the
pressure in the eye

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because we think
the differential

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between the pressure in
the eye and the pressure

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in the brain may also
be a causative factor

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in this problem.

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>> Brandi Dean: And this is all
stuff that the crew can kind

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of do amongst themselves
without help from the ground?

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Or I guess they get
talked through it, but.

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>> Dr. Christian Otto: Yeah,
and that's a great question.

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And in fact, that the crew
members are obviously extremely

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talented and skilled, yet many

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of these are very
sophisticated medical tests.

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So there's a large team of
folks here on the ground,

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biomedical controllers, we
have subject matter experts

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who actually guide the crew

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through many of these
procedures.

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So they're sort of the eyes
and the crew are the hands

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and they help them
through many of these tests

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to acquire these
medical-grade images.

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So it's a team effort.

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>> Brandi Dean: Okay, and so
far are they doing a good job

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of getting the information
for you?

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>> Dr. Christian Otto: Yeah,
you know, in fact, we have data

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from two crew members now and
they've done a wonderful job

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in collecting this
very sophisticated data

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across many different tests.

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And this is actually helping
us understand this problem

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much better.

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>> Brandi Dean: Okay, great.

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Well, so as you get a better
understanding, any ideas --

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is it something you're
going to be able to prevent

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or is it something
you just accommodate

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on longer-duration missions?

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>> Dr. Christian Otto: Yeah,
and another great question.

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So the concern is for
longer-duration missions,

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so as you're alluding to,
the goal here is to come

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up with treatments
and countermeasures

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to prevent what we
think may be happening.

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And, again, our leading
hypothesis is the cephalad

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fluid shift.

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So some of the possibilities
are mechanical factors

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that help draw some of that
fluid back towards the legs.

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And the Russians use a device
called the brazlet [phonetic],

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which is essentially
a tourniquet

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around each thigh
that's calibrated.

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And that helps keep some of
the venous blood in the legs

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and preventing some of
that cephalad fluid shift.

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That's a potential
countermeasure.

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There's also a negative
pressure suit.

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There's both a U.S. version
and a Russian version

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that is basically like a large
set of pants that you put

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on that creates a negative
suction and draws fluid

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down towards the legs.

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That might not be a perfect
option in the future,

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but there may be other versions
that aren't quite as cumbersome.

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Other things that we're
considering are drug treatments

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and so on.

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So the experiment's
giving us insight

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into what countermeasure
we might be able to employ.

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>> Brandi Dean: So will
these experiments go

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on a long time before
we start seeing some

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of the countermeasure-type
experiments or is

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that coming in the near future?

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>> Dr. Christian Otto: Yeah,
and another great question.

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In fact, following
closely on the heels

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of the ocular health experiment
is the fluid shifts experiment,

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another NASA experiment,

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combined with other outside
investigators, that were sort

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of an occupational or
observational study to look

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at what's happening
to the crew member.

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We're not using any
interventions to see

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if we can change
what's going on,

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but the fluid shifts experiment
will employ the Russian Chibis

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suit, which is a negative
pressure device that's actually

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on board on the Russian segment.

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So this is an exciting
collaborative experiment

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with our Russian colleagues.

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And to actually look
at these changes,

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and the changes we're
seeing in the crew now,

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can they be reversed
using, for example,

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the Chibis negative
pressure suit?

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So that will give us
a clear indication

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if that's a viable
counter-measure.

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>> Brandi Dean: Okay, well
I'm sure we'll be hearing more

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from you about that soon.

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In the meantime,
is this something

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that could help us here on
earth or is it just for people

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who are going to space?

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>> Dr. Christian Otto: Yeah, and
that's another great question.

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And, you know, with
this problem,

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the visual
impairment-intracranial pressure

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problem, we're really on the
cutting edge of several areas

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of clinical and medical
science here on the ground.

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For example, understanding
diseases of the eye

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that involve intraocular
pressure and the difference

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between intraocular and
intracranial pressure,

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such as glaucoma, better
understanding diseases

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that lead to papilledema.

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Also diseases that
involve circulation

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of cerebral spinal
fluid in the brain,

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such as idiopathic intracranial
hypertension or hydrocephalus.

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Another exciting thing is the
development of new technologies

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that will play a critical
role in medicine on earth,

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such as ways to measure
intracranial pressure

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without drilling a
hole in someone's skull

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and putting in a device.

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This is very exciting with huge
implications for, you know,

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head trauma and neurosurgery
and neurology; and also ways

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to measure diseases of the
eye, such as ultrasound,

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which many of these techniques
are being pioneered right here

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at NASA.

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>> Brandi Dean: Sounds
like it could be good news

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for a lot of people.

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>> Dr. Christian
Otto: Definitely.

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>> Brandi Dean: Well,
thanks so much

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for coming and talking with us.

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We really appreciate it and...

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>> Dr. Christian
Otto: My pleasure.

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>> Brandi Dean: ...with
that said,

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I'm sure we'll have you
back to give us more updates

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as the experiments go on.