Do Your Genes Affect How Fast Glaucoma Progresses? A Review of 18 Studies

Primary open-angle glaucoma is the most common type of glaucoma and a leading cause of irreversible blindness. Two people with similar eye pressure can progress at very different speeds. Genetics is one reason researchers suspect, but most genetic studies focus on who gets glaucoma rather than how quickly it worsens. A systematic review from University Hospitals Leuven in Belgium looked specifically at progression.

What the review covered

Brackenier and colleagues searched six major databases following PRISMA guidelines and included 18 studies of adults with primary open-angle glaucoma. Each study looked at whether specific gene variants were linked to structural or functional signs of progression.

Variants linked to faster change

• Certain HLA class I haplotypes and MYOC.mt1 carriers showed faster optic-nerve damage.
• The APOE e4 variant was linked to faster macular thinning in normal-tension glaucoma.
• People with two copies of the Val form of BDNF rs6265 had faster loss of the retinal nerve fiber layer, especially women.
• Variants in TGFBR3-CDC7 and MYOC.mt1 were linked to faster visual-field loss.
• Variants in GAS7, IL1B, and OPTN were associated with a higher chance of needing surgery.
• Results for ABCA1, CDKN2B-AS, eNOS, and Piezo1 were inconclusive.

What this means today

The authors said these findings support a role for genes in glaucoma progression and highlight the potential of genetic screening to flag people at risk of rapid worsening. That is a potential, not yet routine practice. Glaucoma progression is multifactorial, with genetic, environmental, vascular, and mechanical influences.

Practical steps

• Tell your eye doctor about family members with glaucoma, especially anyone who lost vision.
• Keep regular optic-nerve imaging and visual-field tests; they remain how we measure your actual rate of change.
• Ask whether genetic testing or research participation makes sense for you.

For more reading on eye health as we age, see bettervisionatanyage.com.

Source: Gene polymorphisms associated with progression of primary open-angle glaucoma: A systematic review (Survey of Ophthalmology (PubMed), 09/17/2026). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.