Understanding the psycho-neuro-endocrine-immunology pathways in glaucoma and their modulation by mindfulness meditation
Hemlata Udenia, Nitika Beri, Aafreen Bari, Tanuj Dada
Indian Journal of Ophthalmology September 29, 2026 DOI: 10.4103/ijo.ijo_15_26 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Peer reviewed |
|---|---|
| Intervention | Mindfulness meditation |
| Topics | Meditation |
| Key findings | Argues that chronic stress, acting through neuroendocrine, autonomic, and inflammatory pathways within a Psycho-Neuro-Endocrine-Immunology framework, may contribute to glaucoma beyond intraocular pressure. Proposes mindfulness meditation as a possible nonpharmacological adjunct modulating cortisol, autonomic balance, neuroinflammation, and oxidative stress, while noting that current evidence is limited by heterogeneous study designs and calls for larger standardized prospective studies. |
Abstract
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.
Comparable studies
Other narrative reviews on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical populations | 2003 | Review | |
| Mindfulness: Theoretical Foundations and Evidence for its Salutary Effects | 2007 | Review | |
| Mindfulness Interventions | 2016 | Review | |
| Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation | 2017 | Review | |
| Mindfulness and acceptance: expanding the cognitive-behavioral tradition | 2005 | Review |
Citations in the library
Cites 25
- A systematic review of neurobiological and clinical features of mindfulness meditations Psychological Medicine November 27, 2009
- Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology June 1, 2011
- Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: A randomized dismantling trial. Journal of Consulting and Clinical Psychology December 3, 2013
- Resting-state fMRI functional connectivity and mindfulness in clinical and non-clinical contexts: A review and synthesis. Neuroscience & Biobehavioral Reviews February 22, 2022
- Neurobiological Changes Induced by Mindfulness and Meditation: A Systematic Review. Biomedicines November 15, 2024
and 20 more in the library