Retinal Ganglion Cell Degeneration in Glaucoma: Systematic Review.

Area of Science:

• Ophthalmology
• Neuroscience
• Regenerative Medicine

Background:

• Retinal ganglion cell (RGC) degeneration is the primary cause of vision loss in glaucoma.
• Elevated intraocular pressure (IOP) is a key risk factor, but RGC death involves multiple mechanisms like mechanical stress, vascular issues, metabolic dysfunction, and neuroinflammation.
• Continued RGC loss despite IOP control necessitates exploring novel therapeutic strategies.

Purpose of the Study:

• To systematically review current research on RGC degeneration in glaucoma.
• To evaluate neuroprotective and regenerative therapies for glaucoma.
• To identify the role of advanced imaging and biomarkers in managing glaucoma.

Main Methods:

• A PRISMA-guided systematic review was performed.
• Searches included major scientific databases (PubMed, Cochrane Library, etc.) up to January 2026.
• PICOS criteria defined study eligibility for RGC degeneration and therapies in glaucoma.

Main Results:

• Optical coherence tomography (OCT) and imaging biomarkers are crucial for early glaucoma detection, risk stratification, and monitoring treatment response.
• Emerging neuroprotective strategies target excitotoxicity, oxidative stress, mitochondrial dysfunction, and neurotrophic insufficiency.
• Stem cell and gene-based regenerative therapies are under active investigation.

Conclusions:

• Mechanism-based interventions are needed for glaucoma, as IOP control alone is insufficient for many patients.
• Integrating molecular insights with advanced imaging and biomarkers can lead to earlier, personalized glaucoma interventions.
• Further research into neuroprotective and regenerative therapies holds promise for preserving vision in glaucoma patients.