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Glaucoma is one of the leading causes of blindness in the world, but with advances in technology, early diagnosis is becoming increasingly accessible and accurate. One of the most promising innovations in this field is the use of theeye tracking, a technology that allows eye movements to be monitored to identify early signs of the disease.

What is Glaucoma?

Glaucoma is a chronic degenerative disease that is the second leading cause of blindness in the world. According to the WHO World Vision Report 2025, it affects about 76 million people worldwide, in the 40-80 age group.

Approximately 50% of glaucoma sufferers are unaware of it, as the disease is often noticed when visual changes are already very advanced, whereas previously no symptoms were felt. This is referred to as the 'silent thief of sight'.

If glaucoma is diagnosed early and properly treated, it can be effectively controlled, allowing in most cases good vision throughout life.

Risk factors

The main risk factors associated with the onset of glaucoma are: advanced age, a family history of the disease, certain pathological conditions such as diabetes, certain drug therapies, and especially a high intraocular pressure (IOP).

The IOP value is determined by the amount of aqueous humour, the transparent liquid produced by the ciliary bodies, present inside the eye between the cornea and the lens. In a healthy eye, the ratio of aqueous humour produced to aqueous humour excreted is such that a constant intraocular pressure is maintained, usually between 11 and 20 mmHg.

In the presence of glaucoma, this relationship is altered, most often due to reduced elimination of the aqueous humour through the trabecular meshwork, the structure that allows it to escape from the eye.

Glaucoma can be classified in several ways:

- Depending on the aetiology, glaucoma can be primarywhen it occurs in the absence of other ocular or systemic pathologies, or secondaryif associated with pre-existing pathologies;

- Based on the altered outflow of the aqueous humour, we distinguish the open-angle glaucomadue to increased resistance to outflow at the level of the trabecularis and closed anglewhere there are anatomical problems that prevent the aqueous humour from reaching the trabecularis;

- Based on the value of the main risk factor, IOP, there is high-pressure glaucoma and normal-pressure glaucoma.

Added to these are congenital glaucoma, if IOP is elevated from birth, and infantile glaucoma if it occurs during the first years of life.

Impact on Sight

Glaucoma impairs vision mainly through progressive damage to the nerve fibres that make up the optic nerveresulting in a gradual loss of the visual field, often starting with peripheral vision.

Over time, untreated glaucoma can lead to a complete blindness and since optic nerve damage is permanent, prevention and early diagnosis become crucial.

Many patients do not notice symptoms until the disease is advanced. For this reason, it is important to have regular eye check-ups, especially for those exposed to risk factors.

Eye Tracking and Glaucoma

Eye tracking, an innovative technology that detects and analyses eye movements, is an important innovation in the early diagnosis of glaucoma.

Using sensors and cameras, it monitors how the eyes move and react to various stimuli:

1. Movement detection: sensors detect eye movements.
2. Data analysis: the data collected are analysed to identify any anomalies.
3. Interpretation: findings may indicate early signs of glaucomatous pathology.

Eye tracking offers numerous advantages over traditional diagnostic methods and is able to detect imperceptible changes in eye movements.

This technology not only improves diagnostic accuracy, but also increases patient comfort during the examination.

In recent years, eye-tracking technology è become more accurate and accessible, enabling wider clinical applications. New versions of eye-tracking devices offer improved resolution and faster response times, enabling a more accurate and timely diagnosis.

In addition, many of these devices are now integrated with advanced data analysis software, which facilitates the detection of glaucoma-related eye movement abnormalities.

In one published study in the Journal Eye Movement Researchi patients with primary open-angle glaucoma showed significant abnormalities in saccadic eye movements on eye tracking, particularly in the tracking of moving objects. With the newly developed algorithm, it was possible to distinguish healthy subjects from those with primary glaucoma with a high sensitivity and specificity of 88.5% and 86.7%, respectively. The very relevant result is that these oculomotor deficits could be detected in patients who had not yet developed the perimetric damage typical of glaucoma and detectable by visual field examination using standard automated perimetry. The strong correlation between saccadic parameters and traditional glaucoma metrics shows that eye movements can, therefore, represent a parameter for measuring the functional consequences of glaucomatous damage and that eye tracking has great potential as a complementary investigative tool for early diagnosis.

Early Diagnosis of Glaucoma

Early diagnosis of glaucoma is crucial to prevent irreversible visual impairment. In this section, we will review the importance of early diagnosis, the role of biomarkers, and current studies and research that support these advances.

Importance of Early Diagnosis

Early identification allows treatments to be initiated that slow down the progression of glaucoma. Patients who receive early treatment are more likely to maintain good visual function and are at less risk of blindness.

Regular check-ups and the use of technologies such as eye tracking increase the chances of an early and accurate diagnosis.

Glaucoma research is constantly evolving. Numerous studies are underway to improve the diagnosis and treatment of this disease.

• Clinical studies are evaluating the effectiveness of eye tracking in early diagnosis.
• Interdisciplinary projects combine technology and medicine for innovative diagnostic solutions.
• Biomarker research explore new indicators to identify glaucoma.

I biomarkers are biological indicators that help identify the presence of a disease. In the case of glaucoma, biomarkers can provide early signs of the disease.

These markers are detected through non-invasive examinations and are crucial for early diagnosis. Recent studies show how biomarkers can be integrated with eye tracking for an even more precise diagnosis of glaucoma.

Benefits of Eye Tracking

The adoption of eye tracking in glaucoma diagnosis offers many advantages. In this section, we will explore how this technology improves diagnostic accuracy, accessibility and convenience of treatment, and its impact on quality of life.

Improving Diagnostic Accuracy

The integration of eye tracking into diagnostic processes has improved the accuracy with which glaucoma is detected. This technology can identify abnormalities in eye movements that escape traditional methods.

Eye tracking provides detailed and objective data, reducing the margin for human error.

In addition, patients can receive a quicker diagnosis, enabling early intervention and improving treatment prospects.

Eye tracking is making glaucoma diagnosis more accessible and convenient. Eye tracking devices are easier to use and take less time than traditional tests.

• Ease of useIt does not require complex preparations.
• Reduced examination timeallows more tests to be performed in less time.
• Non-contactincreases patient comfort during the examination.

These factors make eye tracking a practical choice for clinics and hospitals, expanding access to early diagnosis, which can prevent disease progression and subsequent vision loss.

Continuous and non-invasive monitoring also increases the psychological well-being of patients.

Challenges and Future Prospects

The use of eye tracking currently has some limitations and not all patients can benefit equally from this technology.

• High initial costsequipment can be expensive.
• Requires specialised trainingto interpret the data correctly.
• Individual variabilityEye movements may differ between individuals.

Addressing these limitations is essential to improve the effectiveness of eye tracking in glaucoma diagnosis.

The development prospects for eye tracking are promising. Continued research may lead to cheaper and more accessible devices.

• Integration with artificial intelligenceto improve data analysis.
• Interdisciplinary collaborationsto develop new clinical applications.
• Education and Trainingto prepare professionals capable of using this technology.

These developments could further expand the use and effectiveness of eye tracking in the medical field.

• Elgin, C.Y. Eye-Tracking Algorithm for Early Glaucoma Detection: Analysis of Saccadic Eye Movements in Primary Open-Angle Glaucoma. J. Eye Mov. Res. 2025, 18, 18. https://doi.org/10.3390/jemr18030018
• Leitner MC, Hutzler F, Schuster S, et al. Eye-tracking-based visual field analysis (EFA): a reliable and precise perimetric methodology for the assessment of visual field defects. BMJ Open Ophthalmol. 2021 Mar 17;6(1):e000429. doi: 10.1136/bmjophth-2019-000429. PMID: 33791433; PMCID: PMC7978082.