{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:49:35Z","timestamp":1769820575674,"version":"3.49.0"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mediators of Inflammation"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To analyze the direct and indirect associations between structural, functional, and systemic variables in patients with primary open\u2010angle glaucoma (POAG), normal\u2010tension glaucoma (NTG), and controls using structural equation modeling (SEM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross\u2010sectional observational study was conducted including 156 participants: 55 with POAG, 49 with NTG, and 52 age\u2010 and sex\u2010matched controls. Clinical variables included intraocular pressure (IOP), central corneal thickness (CCT), vertical cup\u2010to\u2010disc ratio (VCDR), and visual\u2010field mean deviation (MD). Systemic variables comprised age and cardiovascular risk factors (hypertension, diabetes, and dyslipidemia). SEM was applied to assess direct and indirect effects on the diagnosis of glaucoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The model showed a good overall fit (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      (9)\u2009=\u200915.968;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.068;\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \/df\u2009=\u20091.774; CFI\u2009=\u20090.972; RMSEA\u2009=\u20090.071) and explained 46.0% of the variance in glaucoma diagnosis (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.460). The most influential predictors were VCDR (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.40), age (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.14), and cardiovascular risk factors (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.19). A significant negative correlation was observed between CCT and MD (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u20130.29), indicating greater functional damage in eyes with thinner corneas. An inverse association between cardiovascular risk burden and IOP was also identified (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u20130.18).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings support the hypothesis of distinct glaucomatous phenotypes, including a vascular subtype with lower IOP and altered perfusion, potentially influenced by systemic comorbidities and chronic treatments. Reduced CCT was also confirmed as an independent marker of advanced functional loss. SEM helps disentangle complex mechanisms and may inform personalized therapeutic strategies, particularly in NTG.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/mi\/7874763","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T13:18:00Z","timestamp":1769779080000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Phenotypic Heterogeneity in Glaucoma: The Systemic and Vascular Landscape Behind Functional Loss"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4881-2940","authenticated-orcid":false,"given":"Jos\u00e9 Enrique","family":"Mu\u00f1oz de Escalona Rojas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Luis","family":"Garc\u00eda Serrano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pablo","family":"Navarro Mart\u00ednez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"e_1_2_10_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2014.05.013"},{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-92971-w"},{"key":"e_1_2_10_3_2","volume-title":"StatPearls [Internet]","author":"Gosling D.","year":"2022"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.65.3.28"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(01)00760-6"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1159\/000519247"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joco.2019.06.002"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1080\/17469899.2016.1180246"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0013164413495237"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/srep38283"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2014.07.051"},{"key":"e_1_2_10_12_2","first-page":"46","article-title":"Association of Systemic Hypertension With Intraocular Pressure in Adults: A Systematic Review and Meta-Analysis","volume":"39","author":"Lee S. 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