Glaucoma Update: Protecting and regenerating the optic nerve

Progressive visual loss despite effective lowering of intraocular pressure leads to visual disability and blindness in a minority of glaucoma patients, but as glaucoma is so common this still amounts to a large number of affected individuals. Thus, there remains a need for new treatments to slow visual deterioration in glaucoma patients progressing despite our best efforts, and ultimately to restore visual function after it has been lost.

Neuroprotection aims to augment the benefit provided by IOP lowering in order to slow the rate of RGC cell death and preserving the remaining level of vision. Neuroregenerative approaches are a key target of the National Eye Institute Audacious Goals Initiative and therapies that stimulate regeneration of the optic nerve have recently been shown to restore some visual function in animal models of optic nerve injury. There is a compelling argument for a combined neuroprotective/neuroregenerative approach when considering future treatment strategies for glaucoma.

In this lecture, some of the techniques being explored to protect and regenerate the optic nerve using gene therapy, stem cells and other approaches will be considered. Particular attention will be paid to those strategies that are most likely to be useful clinically and how they might be assessed in cost-effective clinical trials within a realistic timeframe