The ‘Epigenetic Clock’ May Help Predict Glaucoma Progression

A study by 2024 Shaffer Research Grant recipient Felipe A. Medeiros, MD, PhD recently published in the journal Ophthalmology investigates the relationship between accelerated epigenetic aging and the speed of glaucoma progression.

Nearly every cell in your body contains DNA, the master instruction manual for everything in the body. Why then do some cells become liver cells while others become neurons or blood cells? The answer lies in the genes (specific sequences of DNA) that are expressed in different cells during development.

When a gene is not needed (like a liver cell that does not need to express blood cell genes), small chemical tags called methyl groups are added to the unnecessary gene sequences to package them up tightly so that they can’t be made into proteins (which is referred to as gene silencing). These small chemical tags are part of a larger system of DNA alterations called epigenetic modifications.

Unlike DNA, which always has the same components, epigenetic modifications make gene expression dynamic (genes are turned on when they are needed and then turned off when they’re not). Importantly, there are some factors that we can control, like diet, exercise, stress, sleep, and other lifestyle changes that can influence your epigenetics. There are some, however, that we can’t do anything about, like our age, that are also impactful to the epigenome.

Scientists have known since the late 1960s that age strongly impacts the epigenome. As we age, more methyl groups get attached to some of our genes to silence them. Scientists have been able to correlate the amount of methyl groups attached to certain genes to the age of your DNA, also known as your epigenetic (or biological) age. The higher the proportion of genes with those methyl groups attached, the older your DNA appears to be.

No, it cannot. As with any research study, it is important to remember that this paper using 200 glaucoma patients is not meant to represent the entire glaucoma patient population. In fact, even the authors acknowledge that blood samples were collected after glaucoma progression had already occurred; therefore, a causal relationship between epigenetic age and glaucoma cannot be definitively established.

While the information is exciting and gives us another interesting tool to figure out how quickly someone may or may not lose vision from glaucoma, always consult your doctor or a health care professional before making significant changes to your lifestyle. Importantly, the epigenetic clock tests used in this study are not FDA-approved and are generally marketed as wellness products. They are not intended to diagnose, monitor, or treat disease.

The study hypothesized that the differences between a person’s epigenetic age, as measured by four different epigenetic clock tests, and their chronological age may be a significant risk factor in predicting glaucoma progression. Specifically,they wondered if patients with faster-progressing glaucoma would also have accelerated biological age compared to those with slower progression.

This was a retrospective study where the investigators reviewed medical histories from 200 patients with primary open-angle glaucoma (POAG). Charts from one hundred (100) patients who were identified as having fast-progressing glaucoma were compared to charts from one hundred (100) patients with slow-progressing glaucoma. The doctors also took blood samples from each patient and used four different tests – the Horvath, Hannum, PhenoAge, and GrimAge epigenetic clock tests – to calculate each patient’s biological age.

Using the patients’ glaucoma test results as well as the results from their epigenetic age tests, Dr. Medeiros and colleagues found that people with faster glaucoma progression also had significantly older epigenetic age (nearly three years older than their calendar age compared to the slow-progressing group). The study concluded that accelerated biological aging may make a person’s eye more vulnerable to damage from glaucoma. These findings suggest that biological age could be used as a tool to predict how quickly someone’s glaucoma might get worse, but more studies need to be done on the topic before that is confirmed.

If you are concerned about aging and the risk of glaucoma progression, the good news is that research suggests that healthy lifestyle choices may measurably slow down, or even reverse, your biological age! We have a whole page dedicated to alternative therapies for glaucoma, which you can find here.

As you may suspect, increasing your consumption of dark leafy greens, cruciferous vegetables like broccoli, beets, pumpkin seeds, and sunflower seeds daily is a great place to start! Interestingly, some natural plant compounds like turmeric, rosemary, garlic, berries, and green tea have been shown to reduce epigenetic age by ensuring a balance in the amount of methyl groups that get attached to your genes.

Prioritizing structured exercise helps, too. A study showed that just eight weeks of combined aerobic and strength training reduced biological age in previously sedentary middle-aged women, especially in their blood and muscle cells. Do something that you enjoy and can make into a routine — walking, weightlifting, swimming, even tai chi have been shown to reduce the pace of biological aging. However, if you are a glaucoma patient already, be mindful of yoga and other exercises that involve inversions, like head- or shoulder-stands, which may affect your intraocular pressure (IOP).

Finally, be mindful of sleep! Chronic insomnia symptoms in women have been associated with accelerated biological aging, making stress management and a consistent sleep routine a powerful anti-aging strategy. Create a wind-down ritual for yourself! It’s been shown that turning off your devices a half hour before bedtime is a great way to improve sleep quality. Instead, consider meditation, gentle stretches, or reading a book before shutting your eyes.

While there currently is no known cure for glaucoma, adopting healthy lifestyle choices and taking good care of the cells in your body is a great way to help yourself as you age. We at Glaucoma Research Foundation have been dedicated to curing glaucoma and restoring vision through innovative research for more than 45 years through innovative research and patient advocacy.

—

Felipe A. Medeiros, MD, PhD is a Professor of Ophthalmology and the Vice-Chair of Research at the Bascom Palmer Eye Institute, University of Miami. He was awarded a GRF Shaffer Grant for Innovative Research in 2024 for his research in race, polygenic risk scores, and glaucoma progression.

Article by Cynthia Steel, PhD, MBA. Posted on November 24, 2025.