Novel Neurologic Approach to Glaucoma Therapy Described

Glaucoma pathophysiology suggests preventing retinal ganglion cell neurodegeneration may be key

TUESDAY, March 13 (HealthDay News) -- Neurologic-based therapies may represent a more successful strategy for managing glaucoma versus intraocular pressure (IOP)-lowering therapies, according to a review published online Feb. 20 in Ophthalmology.

Elma E. Chang, M.D., and Jeffrey L. Goldberg, M.D., Ph.D., of the Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, reviewed the literature regarding the pathophysiology of glaucoma and potential new therapeutic targets to surmount the neurodegeneration of retinal ganglion cells (RGCs).

The authors report that IOP-lowering therapy is inadequate and, consequently, RGC neurodegeneration is not being targeted. Neuroprotective therapies have passed various stages of preclinical and clinical testing, including the N-methyl-D-aspartate glutamate receptor antagonist memantine, and the α2-adrenergic agonist brimonidine. Other agents currently being tested include a small interfering RNA-based caspase inhibitor. Optic nerve regeneration approaches include blocking inhibitory signals, enhancing intrinsic growth, and targeting neurotrophic factors. Due to the difficulties and long-term progress necessary to confirm neuroprotection or neuroregeneration, demonstration of neuroenhancement may allow new agents and therapies to be moved to clinical testing.

"Although IOP lowering will remain a mainstay of glaucoma therapy and is certainly a successful 'neuroprotectant' in itself, the motivation for complementary approaches to glaucoma therapy is higher than ever," the authors write. "Such novel therapies may provide IOP-independent treatment for glaucoma compatible with or overcoming the need for lowering IOP; enhance RGC function in the short term, improving patients' vision; and point toward shorter paths to clinical testing and ultimately augment patients' access to new therapies."

Abstract (http://www.ophsource.org/periodicals/ophtha/article/S0161-6420(11)01049-9/abstract )Full Text (subscription or payment may be required) (http://www.ophsource.org/periodicals/ophtha/article/S0161-6420(11)01049-9/fulltext )

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