Research Progress of Diabetes-related Glaucoma: Mechanisms, Impacts and Management Strategies

Diabetes mellitus (DM), a highly prevalent metabolic disorder, is increasingly recognised for its significant association with glaucoma, a leading cause of irreversible vision loss. This review systematically synthesises recent advances in understanding DM-related glaucoma, focusing on its epidemiological links, core pathophysiological mechanisms and contemporary management strategies. The review elaborates on the dual-pathway model of glaucoma pathogenesis in diabetics, encompassing the aqueous humour dynamics pathway leading to neovascular glaucoma and the intraocular pressure -independent neurodegenerative pathway causing direct retinal ganglion cell injury. These pathways are driven by chronic hyperglycaemia, microvascular dysfunction, oxidative stress and neuroinflammation. The presence and severity of diabetic retinopathy, particularly proliferative diabetic retinopathy, markedly heighten the risk. The potential neuroprotective roles of anti-diabetic agents like metformin and GLP-1 receptor agonists beyond glycemic control are discussed. The review underscores the imperative of early detection through regular screening, the challenges of patient adherence and the application of modern technologies like optical coherence tomography angiography and artificial intelligence for monitoring. Finally, the need for individualised, multidisciplinary management to preserve vision is emphasised, and future research directions, including mechanistic studies and precision medicine approaches are outlined.