Glaucoma and cognition: a systematic review and meta-analysis of cognitive metrics in glaucoma patients

To evaluate whether glaucoma is associated with reduced performance on standardized cognitive assessments and to characterize the affected cognitive domains.

A systematic review was conducted using MEDLINE, Embase, Cochrane CENTRAL, and Web of Science from inception to March 2026. Eligible studies included adult glaucoma patients assessed with validated cognitive tools. Meta-analysis was performed for the Mini-Mental State Examination (MMSE), with pooled mean differences (MD) calculated using random-effects models. Indirect subgroup comparisons were performed by glaucoma subtype, geography, and age. Narrative synthesis was performed for MoCA and cognitive domain-specific assessments.

Twenty-four studies (n = 16 569) were included. MMSE meta-analysis suggested lower MMSE scores among glaucoma patients compared with controls (MD: -2.85; 95% CI: -3.36 to -2.34; p < .001), although substantial heterogeneity was present (I² = 94.5%). Exploratory study stratification suggested greater MMSE reductions in developing countries (MD: -3.79; p < .001) than in developed countries (MD: -0.74; p > .05). Despite lower MMSE performance, scores remained above commonly used thresholds for CI. Narrative synthesis found that MoCA-based studies demonstrated inconsistent findings without a clear difference between glaucoma and comparator groups. Among domain-specific areas, deficits in verbal fluency, visuospatial skills, and memory were suggested. Interpretation of these findings was limited by the visual dependence of cognitive assessments, raising the possibility that visual impairment may reduce scores.

Current evidence suggests a hypothesis-generating association that glaucoma may reduce performance on cognitive assessments. However, interpretation is limited by substantial heterogeneity and the visual dependence of cognitive assessments, highlighting the need for standardized, longitudinal studies to better define the scope and mechanisms of this relationship.