SYSTEMATIC REVIEW article
Front. Psychiatry
Sec. Anxiety and Stress Disorders
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1679419
This article is part of the Research TopicNew Concepts, Advances, and Future Trends in Clinical Research on Eye DiseasesView all 72 articles
The Bidirectional Enigma of Glaucoma and Anxiety: From Neuroinflammatory Mechanisms to Mind-Body Integrated Therapies
Provisionally accepted
- 1Eye Center, Xiamen University, Xiamen, China
- 2Fujian Medical University Xiamen Hong'ai Hospital, Xiamen, China
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Glaucoma, a leading cause of irreversible blindness globally, exhibits a bidirectional association with anxiety that mutually exacerbates both conditions. Epidemiological evidence shows anxiety prevalence in glaucoma patients ranges from 19.07% to 25.71%. This comorbidity is mediated by multi-level mechanisms: Anxiety accelerates glaucoma via neuroendocrine dysregulation (hypothalamic-pituitary-adrenal axis overactivation), vascular dysfunction (sympathetic catecholamine release), and neuroinflammation (microglial IL-1β/TNF-α secretion). Conversely, glaucoma-induced retinal ganglion cell (RGC) apoptosis triggers anxiety through neuroinflammatory cascades (HMGB1/TLR4/NF-κB activation) and abnormal amygdalar connectivity (resting-state fMRI evidence); retinal TNF-α may contribute via analogous retinal-brain pathways, though direct evidence is limited. Clinically, anxiety correlates with 40% reduced treatment adherence, accelerated visual field progression (-1.5 dB/year), and 30% higher postoperative complication risk. Key research gaps include the insufficient availability of longitudinal data, a lack of genetic validation, and the use of unstandardized psychological interventions. This review highlights "mind-body integrated therapy" (cognitive-behavioral therapy with 76% adherence improvement, biofeedback, and SSRIs) as a priority. Future directions focus on biomarker-guided interventions and anti-inflammatory strategies to shift management toward a physiological-psychological co-intervention approach.
Keywords: Glaucoma, Anxiety, Bidirectional mechanism, Neuroinflammation, mind-body therapy, Treatment Adherence
Received: 04 Aug 2025; Accepted: 17 Oct 2025.
Copyright: © 2025 Lin, Tang, Liang and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dongkan Li, xmecldk@163.com
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