The role of RGC degeneration in the pathogenesis of glaucoma

Glaucoma is a neurodegenerative disorder marked by the loss of retinal ganglion cells (RGCs) and axonal degeneration, resulting in irreversible vision impairment. While intraocular pressure (IOP) is presently acknowledged as the sole modifiable risk factor, the sensitivity of RGCs to IOP varies among individuals. Consequently, progressive vision loss may ensue even when IOP is effectively managed. This review consolidates current knowledge regarding the pathogenesis of RGCs in glaucoma and various neurodegenerative diseases. It delves into the mechanisms underlying RGC transsynaptic degeneration and axonal defects in glaucoma from a pathophysiological standpoint, and it elucidates the alterations in the visual pathway throughout the progression of the disease. Furthermore, the article outlines neuroprotective and nerve regeneration strategies aimed at vision restoration in glaucoma patients, offers insights for clinical management of the condition, and investigates prospective avenues for gene therapy.