Molecular profiling implicates immune-driven adaptive homeostasis in maintaining intraocular pressure with age

Aging and ocular hypertension are primary risk factors for glaucoma - a major cause of blindness worldwide. Ocular hypertension results from dysfunction in the outflow tissues - the trabecular meshwork (TM) and Schlemm's canal (SC), which are key regulators of intraocular pressure (IOP) homeostasis. Despite lifelong multifaceted stress to the outflow pathway, ocular hypertension sufficient to develop glaucoma occurs in only a minority of individuals. The mechanisms that preserve physiological IOP with aging in most individuals remain poorly understood. Using single-cell RNA sequencing and protein validation in mouse outflow tissues, we found that aging is accompanied by subtype-specific changes in TM cells, including altered extracellular matrix maintenance, reduced trophic signaling to SC, and increased profibrotic signaling. Coincident with these changes, we observed age-dependent immune remodeling, marked by increased macrophage abundance in outflow tissues. Our model predicts that macrophages maintain SC homeostasis via VEGFA signaling - normally supplied by the TM and required for normal SC function, but impaired with age. This pattern supports a paradigm in which adaptive immune remodeling contributes to preserving IOP homeostasis despite progressive aging-associated cellular dysfunction. More broadly, we identify the TM/SC outflow pathway as a model for understanding how aging tissues preserve physiological function through coordinated structural, trophic, and adaptive immune remodeling.