Surv Ophthalmol. 2021 Dec 07. pii: S0039-6257(21)00223-X. [Epub ahead of print]
Glaucoma, a progressive optic neuropathy characterized by retinal ganglion cell degeneration and visual field loss, is the leading cause of irreversible blindness worldwide. Intraocular pressure (IOP) is presently the only modifiable risk factor demonstrated to slow or halt disease progression; however, glaucomatous damage persists in almost 50% of patients despite significant IOP reduction. Many studies have investigated the non-IOP-related risk factors that contribute to glaucoma progression as well as interventions that can prevent or delay glaucomatous neurodegeneration and preserve vision throughout life, independently of IOP. A vast number of experimental studies have reported effective neuroprotection in glaucoma, and clinical studies are ongoing attempting to provide strong evidence of effectiveness of these interventions. In this review, we look into the current understanding of the pathophysiology of glaucoma and explore the recent advances in non-IOP related strategies for neuroprotection and neuroregeneration in glaucoma.
Keywords: AMD, Age-related macular degeneration; BDNF, Brain derived neurotrophic factor; CNTF, Ciliary neurotrophic factor; GDNF, Glial‐derived neurotrophic factor; Glaucoma; IOP, Intraocular pressure; LoGTS, Low-Pressure Glaucoma Treatment Study; MRI, Magnetic resonance imaging; MSCs, Mesenchymal stem cells; NGF, Nerve growth factor; NTG, Normal tension glaucoma; OCTA, Optical coherence tomography angiography; PBM, hotobiomodulation; PDGF, Platelet derived growth factor; POAG, Primary open angle glaucoma; RGCs, Retinal ganglion cells; TNF-α, Tumor necrosis factor- α; bFGF, Basic fibroblast growth factor; gene therapy; intracranial pressure; intraocular pressure; neuroprotection; ocular blood flow; oxidative stress; retinal ganglion cells; stem cell therapy