The Future of Glaucoma Care: Protecting the Optic Nerve

In the 2026 AGS Lecture, Louis R. Pasquale, MD, FARVO, discussed how genetics, metabolism, and understanding the impact of myopia on the lamina support system may redefine optic nerve protection.

By
Jim Gallagher, senior managing editor
March 1, 2026
6 min

Glaucoma Physician

At a Glance

Category	Detail
Condition	Glaucoma, specifically primary open-angle glaucoma
Key Mechanisms	Optic nerve vulnerability, intraocular pressure (IOP) modulation, genetic and metabolic factors, myopia impact on lamina support
Target Population	Patients with glaucoma, including those with genetic predispositions and myopia
Care Setting	Ophthalmology clinics and specialized glaucoma care centers

Key Highlights

Glaucoma management must expand beyond IOP control to focus on protecting the optic nerve directly.
Emerging technologies include systemic biomarkers, advanced optic nerve imaging, granular IOP profiling, and genetic risk stratification.
Future treatments may involve mitochondrial enhancement, genetic engineering, and direct neuroprotective interventions at the optic nerve.

Guideline-Based Recommendations

Diagnosis

Use advanced imaging modalities such as spectral-domain and swept-source OCT with Bruch’s membrane landmarks for early detection of glaucomatous optic neuropathy.
Incorporate genetic and polygenic risk scores to enable earlier diagnosis and patient stratification.

Management

Continue IOP-lowering strategies while integrating treatments targeting optic nerve protection and mitochondrial function.
Utilize minimally invasive glaucoma surgery techniques potentially to deliver genetic therapies.
Consider multiomic risk profiles (genomics, metabolomics, proteomics, epigenetics, microbiome) for precision medicine approaches.

Monitoring & Follow-up

Develop and apply systemic biomarkers, including serum proteomic analyses, to monitor disease activity and treatment effectiveness.
Employ remote IOP monitoring tools to detect non-ambulatory IOP spikes that contribute to progression.

Risks

Be aware of limitations in retinal nerve fiber layer analysis due to anatomical variations like high refractive error, disc torsion, and tilting.
Recognize that current glaucoma treatments may cause side effects such as miosis and cataract formation.

Patient & Prescribing Data

Patients with primary open-angle glaucoma, including those with genetic risk factors and myopia

Polygenic risk scores assist in early diagnosis and aggressive treatment; future therapies may include mitochondrial enhancers and gene-based interventions.

Clinical Best Practices

Expand clinical focus from solely IOP reduction to comprehensive optic nerve protection strategies.
Incorporate genetic and multiomic data into clinical decision-making for personalized glaucoma care.
Train clinicians in minimally invasive surgical techniques and potential future neuroprotective optic nerve interventions.