Modulation of microRNAs by natural compounds: A potential new strategy for glaucoma treatment

Glaucoma is a progressive optic neuropathy and a leading cause of irreversible blindness, characterized by retinal ganglion cell loss and optic nerve degeneration. While elevated intraocular pressure (IOP) is the main modifiable risk factor, disease progression can occur independently of IOP, implicating oxidative stress, inflammation, mitochondrial dysfunction, and extracellular matrix remodeling in its pathogenesis. MicroRNAs (miRNAs), small non-coding RNAs that regulate gene expression, have emerged as promising modulators of these pathways and potential therapeutic targets, although clinical application remains limited by delivery challenges and variable findings. Emerging evidence suggests that certain natural compounds and plant-derived bioactive agents can influence miRNA activity, with potential neuroprotective effects. Although direct evidence in glaucoma is still limited, studies in related neurodegenerative and inflammatory conditions indicate a promising therapeutic avenue. This review discusses the potential of miRNA-targeted phytotherapy as a novel strategy to modulate key pathogenic pathways and enhance neuroprotection in glaucoma. Future research should focus on standardized methodologies and robust clinical validation to translate these findings into therapeutic applications.