Glaucoma

The grounding supports glaucoma as a heterogeneous disease rather than a single-cause disorder. Elevated intraocular pressure is central to many forms, and impaired retinal blood flow is also implicated in initial optic nerve damage. The literature also points to trabecular meshwork dysfunction in primary open-angle glaucoma as a contributor to elevated intraocular pressure.

Glaucoma pathophysiology is complex and multifactorial. Elevated intraocular pressure and/or reduced retinal blood flow can initiate optic nerve injury, while ongoing mechanical and vascular stress, oxidative stress, mitochondrial dysfunction, excitotoxicity, and neuroinflammation contribute to retinal neurodegeneration and progression. Dysfunction of para-inflammation in the retinal ganglion cell layer and optic nerve head, and in some forms anterior chamber mechanisms affecting the trabecular meshwork, are also described.

For primary open-angle glaucoma, the grounding identifies older age, elevated intraocular pressure, sub-Saharan African ethnic origin, positive family history, and high myopia as risk factors. For primary angle-closure glaucoma, older age, hyperopia, and east Asian ethnic origin are the main risk factors. Age is a risk factor across both major forms.

Treatment is generally aimed at lowering intraocular pressure, which can halt progression when reduced substantially from baseline. The grounding supports therapy and surgery as management modalities, but does not provide specific drug classes beyond cannabinoids being studied for glaucoma. Early ophthalmological examination is emphasized for diagnosis and management.