Non‐IOP lowering treatment

Abstract

AbstractThe classical glaucoma treatment focuses on IOP reduction. Better knowledge of the pathogenesis has opened up new therapeutical approaches. Whilst most of these new avenues of treatment are still in the experimental phase, others, are already used by some physicians. Blood pressure dips can be avoided by intake of salt or fludrocortisone. Vascular regulation can be improved locally by carbonic anhydrase inhibitors, systemically with magnesium or with low doses of calcium channel blockers. Experimentally, glaucomatous optic neuropathy (GON) can be prevented by inhibition of astrocyte activation, either by blockage of epidermal growth factor receptor or by counteracting Endothelin. GON can also be prevented by nitric oxide‐2 synthase inhibition. Inhibition of matrix metalloproteinase‐9 inhibits apoptosis of retinal ganglion cells and tissue remodelling. Upregulation of heat shock proteins protects the retinal ganglion cells and the optic nerve head. Reduction of oxidative stress especially at the level of mitochondria also seems to be protective. This can be achieved by gingko, dark chocolate, polyphenolic flavonoids occurring in tea, coffee or red wine and anthocyanosides found in bilberries.