Function: noun
Etymology: Latin, cataract, from Greek glaukōma, from glaukoun to have a cataract,from glaukos
Date: 1885
: a disease of the eye marked by increased pressure within the eyeball that can result in damage to the optic disk and gradual loss of vision
Now glaucoma is considered a primary optic neuropathy where ocular hypertension alone is not sufficient or necessary for development or progression
New concepts in treatmentPreserve neuronal tissue by interfering with injury and death pathways
Provide a therapeutic regimen, independent of IOP, for slowing or preventing death of neurons and maintaining their function
Amyotrophic lateral sclerosis:
Riluzole
Alzheimer disease:
Memantine
What works
Therapeutic Options
Supplement neurotrophic factors
– Exogenous BDNF effect temporary
– Need to upregulate receptors (AAV)
– Encapsulated cell intraocular implants (phase I clinical trials)
Peptomimetic ligands
– More specific, longer lasting than neurotrophic factors
Glutamate
– Main excitatory neurotransmitter in CNS and retina
– Released in pre-synaptic terminals throughout retina and binds to a variety of receptors (including NMDA type)
– Excessive expression is neurotoxic
– Chronic NMDA intravitreal injection causes glaucoma-like histology changes in animal retina
Increased glutamate in vitreous of gluacoma patients? (author of this study discredited)
Therapeutic Options
Memantine
– Only currently available clnical glutamate modifier
– 1960s by Eli Lilly
– NMDA-receptor antagonist
– Uncompetitive open-channel blocker
inhibits receptor activity when glutamate is at super-physiologic levels
Immune deficient mice
– reduced neuronal survival after neuronal insult
MS
- Copaxone
–
“protective” autoimmune T cells create a neuroprotective environment
Mitochondrial dysfunction shown to occur in experimental glaucoma
External stress can trigger mitochondrial dysfunction which can lead to production of ROS which cause cell death at neurotoxic levels
Significant increase in levels of ROS and lipd peroxides in experimental glaucoma eyes along with changes in activities of antioxidant enzymes
Other Therapeutic Options
Vitamin E
– Improved visual fields?
– Long term studies less convincing
Extract Gingko biloba
– Increase survival of RGCs in experimental glaucoma
– Interfere w/ glutamatergic NMDA receptor
– Mode of action not fully understood
In glaucoma, people can get blindness. It is very dangerous disease which can damage eye sight very badly. These above medicine can help to prevent this damage.
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