Editorial: Update on Glaucoma Research: From Basic Science to Clinical Practice

Alessio Martucci ^1* Maria Dolores Pinazo-Duran ² Carlo Nucci ¹

• ¹ University of Rome Tor Vergata, Roma, Italy
• ² Ophthalmic Research Unit 'Santiago Grisolia', Foundation for the Promotion of Health and Biomedical Research of the Valencian Community, Valencia, Spain

In this regard, a qualitative study by Liu et al. exploring factors associated with delayed ophthalmological consultation in primary glaucoma patients highlighted four major barriers: the subtle onset of symptoms, insufficient patient awareness, perceived challenges in accessing care, and inadequate support systems. These findings underscore the urgent need for improved public health initiatives, patient education, and streamlined referral pathways to encourage early detection and prevent irreversible vision loss. Healthcare professionals should prioritize educating at-risk populations and integrating community-based screening programs to address these barriers effectively. (3) Accurate IOP measurement is also a critical factor for glaucoma management. In a comparative study between the Goldmann Applanation Tonometry and the SUOER SW-500 Rebound Tonometer, Chaung et al. revealed that the latter provides comparable readings within the normal IOP range but may underestimate elevated pressures. While rebound tonometry offers advantages such as portability and disposable probes to minimize infection risk, clinicians should remain cautious when relying solely on this method in patients with high IOP. Future research should explore the refinement of non-contact tonometry techniques to enhance precision and reliability. (4) Novel biomarkers also offer a promising avenue for improving glaucoma diagnosis, prognosis, and treatment response assessment. By identifying molecular, genetic, and biochemical markers associated with glaucomatous neurodegeneration, clinicians can detect the disease earlier, differentiate subtypes, and personalize treatment strategies. Biomarkers found in the aqueous humor, tear film, blood, and even imaging-based parameters could provide valuable insights into disease mechanisms and therapeutic targets. (5) In this contest, given the neuroprotective role of uric acid (UA) in neurodegenerative disorders, its relationship with glaucoma has been the subject of investigation. A meta-analysis of multiple studies authored by Mohammadi et al. revealed that while glaucoma patients tend to have slightly higher serum UA levels than controls, the difference is not statistically significant. While these findings do not establish UA as a definitive biomarker for glaucoma, further longitudinal research is necessary to elucidate its potential role in disease pathogenesis. (6) In a recent molecular research Yu et al. have also identified apoptosis-related microRNAs (miRNAs) as potential biomarkers in glaucoma. Elevated levels of hsa-miR-193a-5p and hsa-miR-222-3p in aqueous humor and lens capsules suggest their involvement in glaucoma pathophysiology. The downregulation of PTEN, a key regulatory gene, further supports their role in retinal ganglion cell apoptosis. These findings pave the way for novel diagnostic and therapeutic strategies leveraging miRNA modulation. (7) Evalua�ng local and systemic aspects is essen�al for comprehensive glaucoma management, as they can impact treatment response, disease progression, and overall pa�ent outcomes. A mul�disciplinary approach integra�ng ophthalmology, cardiology, neurology, and internal medicine may help op�mize glaucoma care and preserve visual func�on.As glaucoma incidence rises globally, pa�ents require prolonged medical therapy and mul�ple surgeries, increasing systemic and local adverse events such as limbal stem cell deficiency (LSCD) risk.In glaucoma, LSCD may be associated with multiple limbal surgeries, bullous keratopathy, mitomycin C, 5-fluorouracil, and preservatives in topical treatments. Using confocal microscopy and optical coherence tomography Nakakura et al. have demonstrated limbal epithelial thinning in glaucoma patients using topical medications. (8) Vascular dysregula�on, systemic hypertension, hypotension, diabetes, obstruc�ve sleep apnea, and neurodegenera�ve disorders have also all been implicated in glaucoma pathophysiology. (9)(10)(11) In this regard, an extensive population-based cohort study by Lee et al. examined the impact of visitto-visit blood pressure variability (BPV) on the risk of open-angle glaucoma (OAG) in normotensive individuals. While BPV was not associated with an increased overall risk of OAG, younger individuals (<60 years) with high systolic BPV demonstrated a significantly higher risk of developing the disease. These findings highlight the need for a more nuanced approach to cardiovascular and ocular health monitoring, particularly in younger patients. (12) Furthermore, glaucoma not only affects visual function but also significantly impacts patients' mental well-being. A study by Kopilaš et al. assessing quality of life (QOL) and psychological distress in glaucoma patients demonstrated strong correlations between disease progression, lower visual acuity, and increased anxiety and depression.Although observational studies have suggested a link between glaucoma and psychiatric conditions such as depression, insomnia, and schizophrenia, a Mendelian Randomization study by Zhang et al. and a study on anxiety in glaucoma by Lin et al. found no causal relationship between these disorders. These results indicate that psychiatric conditions in glaucoma patients are more likely attributable to modifiable factors rather than genetic predisposition.The chronic nature of glaucoma, coupled with the gradual decline in vision, underscores the importance of holistic patient care. This highlights the need for targeted psychological support and intervention strategies rather than attributing mental health challenges to inherent disease risk. Mental health support should be integrated into routine glaucoma management to improve overall patient outcomes. (13)(14)(15) Advancements in surgical techniques, including Micro-invasive glaucoma surgery (MIGS), have improved the safety profile of glaucoma surgery, offering less invasive options with faster recovery times. Nevertheless, the selection of the appropriate surgical approach requires careful evaluation of patient-specific factors to optimize outcomes and minimize complications.A recent retrospective study investigated cases of ocular hypertension following EyeCee One preloaded intraocular lens (IOL) implantation. The findings indicated a significant increase in IOP in a subset of patients, emphasizing the importance of careful postoperative monitoring, especially in individuals with a history of glaucoma. González-Martín-Moro et al. suggest that clinicians should remain vigilant about potential IOP fluctuations and consider alternative IOL options where necessary. (16) MIGS has gained traction as a safer alternative to traditional surgical interventions. A retrospective study by Hajduga-Szewczyk et al. evaluating iStent implantation alongside cataract surgery demonstrated significant reductions in IOP and reliance on topical medications. However, patients with higher preoperative IOPs showed limited benefit, suggesting that single iStent implantation may be insufficient for uncontrolled glaucoma cases. Further research into optimizing MIGS techniques is warranted. (17) The recent advancements in glaucoma research highlight the multifaceted nature of the disease, spanning early detection, systemic influences, mental health considerations, and evolving treatment modalities. A concerted effort to enhance patient education, refine diagnostic tools, integrate psychological support, and expand surgical options will be critical in mitigating the global burden of glaucoma. Moving forward, interdisciplinary collaboration between ophthalmologists, primary care physicians, mental health professionals, and researchers will be essential in developing a comprehensive, patient-centered approach to glaucoma care.