Glaucoma is a neurodegenerative disorder primarily characterized by the degeneration of retinal ganglion cells(RGCs). This condition can arise from a complex interplay of multiple mechanisms, including elevated intraocular pressure(IOP), neurotrophic factor deprivation, immune-mediated responses, oxidative stress, and excitotoxicity. Due to the absence of significant clinical symptoms in its initial stages, individuals often remain unaware of the disease until they experience irreversible vision loss, highlighting the critical importance of early diagnosis. Current diagnostic methods predominantly focus on measuring elevated IOP, assessing characteristic visual field deficits, and examining fundoscopic changes in the optic disc. Unfortunately, these indicators typically manifest only after considerable optic nerve damage has already occurred. Consequently, the identification of biomarkers associated with RGCs loss is essential for enhancing the early diagnosis and management of glaucoma. This study aims to investigate the molecular mechanisms underlying RGCs degeneration and to determine the potential existence of biomarkers within these pathways. By identifying early alterations in these biomarkers, we hope to facilitate timely intervention strategies for glaucoma, ultimately reducing the risk of vision loss and improving the overall quality of life for affected individuals.

Normal tension glaucoma(NTG)is a chronic optic neuropathy characterized by progressive damage to the optic nerve and visual field defects, with its pathophysiology closely linked to genetic, immune-inflammatory and vascular factors. Optical coherence tomography angiography(OCTA)is a noninvasive imaging technique that provides real-time, quantitative assessment of retinal microvascular perfusion. In recent years, OCTA has been increasingly applied in NTG studies, demonstrating significant potential in early diagnosis, disease monitoring and management. This systematic review summarizes the latest advancements in the application of OCTA for NTG, with a focus on vascular parameters in the optic nerve head and macular regions. Its diagnostic value and monitoring management are further summarized. Moreover, the current limitations of OCTA technology and the challenges related to its clinical application are critically evaluated, while exploring its future developments. These insights aim to provide a theoretical foundation for further research on NTG-related microvascular pathology and the broader clinical application of OCTA.