Neuroprotection in Glaucoma: A Paradigm Shift

Abstract

Glaucoma is a complex, multifactorial eye disease characterized by loss of retinal ganglion cells (RGCs) and their axons, leading to progressive, irreversible optic neuropathy and visual field loss. The weight of current clinical evidence, therefore, suggests that a novel approach, independent of intraocular pressure (IOP) lowering, aimed at protecting the retinal ganglion cells and optic nerve head from damage is most desirable. The underlying pathophysiologic basis of glaucoma may be attributed to neurodegenerative changes involving multiple pathways and diverse mechanisms. These pathways are potential targets for multifunctional drugs aimed at neuroprotection against glaucoma. The most rational therapeutic approach in reversing or preventing retinal ganglion cell death entails simultaneously targeting these multiple pathways. Hence, the idea of neuroprotection remains a novel therapeutic and promising prospect in the management of glaucoma. This review paper examines current issues on the pathophysiologic basis, potential targets and novel therapeutic approach to neuroprotection in glaucoma.