On-going retinal neuronal degeneration despite clinical stability in glaucoma

Glaucoma, a leading cause of irreversible blindness, involves progressive retinal ganglion cell loss. Early detection of this neurodegeneration is critical, yet current clinical methods often identify disease only after substantial damage has occurred. This preliminary study used high-resolution adaptive optics–optical coherence tomography (AO-OCT) to track individual retinal ganglion cells in patients and healthy volunteers over 3 to 5 years. Results revealed higher neurodegeneration in glaucoma compared to normal aging. We observed 4.16 to 6.86% annual decrease in cell density in glaucoma, far exceeding the 0.27% cell loss rate observed in the healthy volunteer group. Critically, AO-OCT detected progression significantly earlier, identifying cell loss 0.74 years before conventional OCT and 1.49 years before visual field testing. These findings demonstrate AO-OCT as a more sensitive tool capable of monitoring glaucomatous damage with superior precision, potentially representing a major advancement over current clinical imaging.