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Summary
- A new study led by Dr. Felipe Medeiros has uncovered a connection between how fast your body is aging at the molecular level and how quickly glaucoma progresses.
- Glaucoma is a leading cause of irreversible blindness, affecting more than 100 million people worldwide.
- Dr. Medeiros’ ultimate goal is to develop blood-based biomarkers that help identify patients at highest risk of glaucoma progression.
A new study published in Ophthalmology has uncovered a connection between how fast your body is aging at the molecular level and how quickly glaucoma progresses. The research, led by Felipe Medeiros, M.D., professor of ophthalmology and vice chair of research at Bascom Palmer Eye Institute, suggests that epigenetic age could be a powerful new biomarker for predicting glaucoma outcomes.
Glaucoma is a leading cause of irreversible blindness, affecting more than 100 million people worldwide. While high intraocular pressure (IOP) is a known risk factor, many patients still experience vision loss even with well-controlled IOP. This study aimed to find out whether biological aging might help explain why.
“We’ve long known that patients can lose vision from glaucoma even when intraocular pressure is well-controlled,” Dr. Medeiros said. “That raises the fundamental question of what else is driving progression. Given the parallels with other neurodegenerative diseases, we wanted to explore whether biological aging could be a hidden factor influencing vulnerability of the optic nerve to damage from glaucoma.”
Epigenetic Age and Glaucoma
Epigenetic age is a measure of biological aging based on DNA methylation—chemical changes that affect how genes are expressed without altering the DNA sequence itself. Think of it as your body’s internal clock, ticking away based on lifestyle, environment and genetics. When your epigenetic age is higher than your actual age, it’s called epigenetic age acceleration. It’s a sign that your body may be aging faster than your chronological age suggests.
Study researchers analyzed 200 patients with primary, open-angle glaucoma, split evenly between those with fast and slow disease progression. They used four different epigenetic clocks—Horvath, Hannum, PhenoAge, and GrimAge—to calculate biological age from blood samples.
Patients were classified based on how quickly their visual field (measured by standard automated perimetry) and retinal nerve fiber layer thickness declined over time.
Study Findings: Faster Aging, Faster Vision Loss
• Faster aging equals faster vision loss: Patients with faster glaucoma progression had significantly higher epigenetic age acceleration, especially using the Horvath and Hannum clocks.
• Horvath clock stood out: Each additional year of Horvath age acceleration increased the odds of fast progression by 15%.
• Normal eye pressure: The link between biological aging and progression was even stronger in patients with glaucoma who had relatively normal eye pressure, suggesting that aging itself may make the optic nerve more vulnerable.
“This is the first study to show that accelerated epigenetic aging is associated with faster glaucoma progression,” said Dr. Medeiros. “It suggests that biological age, not just chronological age, could be an important predictor of disease trajectory, especially in patients who don’t fit the typical high eye pressure profile.”
It also aligns with findings in other neurodegenerative diseases like Alzheimer’s and Parkinson’s, where accelerated epigenetic aging has been linked to disease risk and severity.
Future Research: Blood-Based Biomarkers
While the study was retrospective and can’t prove causation, it lays the groundwork for future research. Could we one day use a blood test to predict who’s at the highest risk of vision loss? Could anti-aging therapies slow glaucoma progression?
Early trials using nicotinamide (vitamin B3) have shown promise in improving retinal function. Combining these approaches with epigenetic insights could lead to more personalized and proactive glaucoma care.
“We’re now building on this work with prospective studies and deeper molecular analyses,” Dr. Medeiros said. “The ultimate goal is to develop blood-based biomarkers that help identify patients at highest risk of progression and eventually to test therapies aimed at slowing the biological aging process to preserve vision.”
The Four Epigenetic Clocks
Epigenetic clocks estimate biological age based on DNA methylation patterns. Here’s a quick guide:
• What it measures: Methylation at 353 CpG sites across multiple tissues (blood, brain, skin, etc.).
• Why it matters: It’s a “universal” clock that works across tissue types and is widely confirmed.
• In this study: Showed the strongest link to glaucoma progression.
• What it measures: Methylation at 71 CpG sites specific to whole blood.
• Why it matters: Tailored for blood-based aging studies, reflecting changes in hematopoietic cells.
• In this study: Also showed a significant, though weaker, association with disease progression.
• What it measures: Methylation at 513 CpG sites, combined with clinical markers like glucose and inflammation.
• Why it matters: Designed to capture physiological decline and mortality risk.
• In this study: Did not show a statistically significant link to glaucoma progression.
• What it measures: Methylation patterns linked to plasma proteins and smoking history.
• Why it matters: Predicts lifespan and health span.
• In this study: Showed moderate association with glaucoma progression.
Tags: aging, Bascom Palmer Eye Institute, Department of Ophthalmology, Dr. Felipe Medeiros, epigenetics, eye diseases, glaucoma, ophthalmology