Understanding the psycho-neuro-endocrine-immunology pathways in glaucoma and their modulation by mindfulness meditation.

Glaucoma is among the leading causes of irreversible blindness worldwide. It is increasingly being recognized as a complex and multifactorial disease with diverse pathogenesis. Elevated intraocular pressure (IOP) remains the primary modifiable risk factor and continues to be the cornerstone of current glaucoma management. The accumulating evidence provided clinical insights that factor beyond IOP may also influence disease onset and progression. In the recent era, chronic stress has emerged out to be one such factor and has been linked to alteration in neuroendocrine, autonomic, and inflammatory pathways. The evolving concept of Psycho-Neuro-Endocrine-Immunology (PNEI) provides an integrative framework to examine these interactions and their possible relevance to glaucoma pathophysiology. The narrative review was carried out on existing evidence that relates biology of stress to glaucoma within the framework of "PNEI" and "Allostatic load." In addition, it will also explore the potential role of mindfulness meditation to serve as a nonpharmacological adjunct capable of modulating key PNEI pathways, which include cortisol regulation, autonomic balance, neuroinflammation, and oxidative stress. The evidence available to date is encouraging regarding the effects of mindfulness-based interventions. However, the current literature is limited by considerable variability in study designs, intervention protocol, outcome measures, and duration of follow-up. Larger prospective studies with standardized intervention and longer follow-up are needed to clarify the role of mindfulness-based intervention in glaucoma care. Integration of PNEI-based approaches may offer a conceptual framework for future research in holistic glaucoma care, pending validation of long-term clinical outcomes.