{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:56:45Z","timestamp":1793642205297,"version":"4.5.1"},"reference-count":102,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Glaucoma, a leading cause of irreversible global blindness, has a bidirectional association with anxiety that worsens both conditions. Anxiety prevalence in glaucoma patients (19.07%\u201325.71%) is much higher than the general population\u2019s 9.8%, and glaucoma patients have a 4.45-fold higher anxiety risk than healthy controls, underscoring the need to synthesize their interactions and interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of PubMed, Web of Science, and Embase (2010\u20132025) identified studies on glaucoma-anxiety bidirectional relationships, mechanisms, and interventions.   Following PRISMA guidelines, 99 studies were screened, with 14 eligible for synthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Bidirectional pathogenesis involves three pathways: (1) Anxiety accelerates glaucoma via hypothalamic-pituitary-adrenal axis overactivation (43% lower retinal ganglion cell [RGC] survival), sympathetic catecholamine release, and microglial IL-1\u03b2\/TNF-\u03b1 secretion (P&amp;lt;0.001); (2) Glaucoma induces anxiety through RGC apoptosis-driven HMGB1\/TLR4\/NF-\u03baB activation and abnormal amygdalar connectivity; (3) Anxiety correlates with 40% reduced treatment adherence, faster visual field progression (-1.5 dB\/year), and 30% higher postoperative complications. Gaps include limited longitudinal data and unstandardized psychological interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>\u201cMind-body integrated therapy\u201d is prioritized: cognitive-behavioral therapy boosts adherence by 76%, biofeedback lowers intraocular pressure by 4.8 mmHg, and SSRIs alleviate anxiety safely. Future research should focus on biomarker-guided and anti-inflammatory interventions to shift management toward physiological-psychological co-care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1679419","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T06:30:29Z","timestamp":1761719429000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["The bidirectional enigma of glaucoma and anxiety: from neuroinflammatory mechanisms to mind-body integrated 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