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Glaucoma Australia
August 2022

A recent study from New York Eye and Ear Infirmary of Mount Sinai has found that a new, 
high-tech imaging method may be able to detect early signs of glaucoma and therefore effectively prevent the onset of irreversible vision loss. 

A close up image of an eye

The study, published in Ophthalmology Glaucoma, focused on measuring flavoprotein fluorescence in the eye and it is the first extensive study to analyse flavoprotein fluorescence changes in the optic nerves in patients with various stages of glaucoma compared to those who do not have eye disease. 

“Glaucoma is difficult to diagnose in early stages, and often physicians agonise to confirm subtle signs of progression in advanced stages. Once structural damage to the optic nerve has occurred, it is currently not possible to reverse. The better we become at identifying early or ongoing degeneration, the more proactive we can be at implementing protective therapy,” says lead researcher Dr Richard B. Rosen.

Mitochondria – which create energy in cells – produce flavoprotein fluorescence when they are stressed, and levels of flavoprotein fluorescence are higher in people with glaucoma compared to those without it. Mitochondrial dysfunction in the optic nerve can eventually lead to loss of cells and tissue damage, leading to multiple eye diseases such as glaucoma and macular degeneration. 

“Our study shows flavoprotein fluorescence may be useful as an objective measure for predicting glaucoma progression earlier than measuring structural damage, with similar sensitivity to visual field changes but easier and potentially more consistently,” adds Dr Rosen.

As part of the study, a team of researchers analysed 86 eyes in which 50 of the eyes had glaucoma and 36 had no disease. They found flavoprotein fluorescence was dramatically higher in glaucoma eyes compared to eyes without glaucoma, especially in early-stage glaucoma cases. As such, the results suggest that flavoprotein fluorescence could serve as a new biomarker.

“Previous studies have demonstrated that when the mitochondrial oxidative stress is relieved by medication or surgery, the flavoprotein fluorescence levels go down. This makes the technique very attractive as a sensitive way of monitoring response to therapy,” says Dr Rosen. “This measurement could potentially be used as a first-line indicator to monitor of glaucoma progression for the patient and the physician,” adds Dr Rosen. 

Moving forward, the team of researchers plan to build upon their findings to determine whether flavoprotein fluorescence can be used to effectively monitor the success of therapy for glaucoma patients as well as to determine when treatment has flattened the risk curve of progression in advanced cases.


Davis B. Zhou, Maria V. Castanos, Lawrence Geyman, Apichat Tantraworasin, Robert Ritch, Collin A. Ritch, Richard B. Rosen. Mitochondrial Dysfunction in Primary Open-Angle Glaucoma Characterized by Flavoprotein Fluorescence at the Optic Nerve Head, Ophthalmology Glaucoma, Volume 5, Issue 4, 2022,