Abstract
Glaucoma is a slow progressive degeneration of the retinal ganglion cells (RGCs) and the optic nerve axons, leading to irreversible blindness if left undiagnosed and untreated. Although increased intraocular pressure is a major risk factor of glaucoma, other factors include increased glutamate levels, alterations in nitric oxide (NO) metabolism, vascular alterations and oxidative damage caused by reactive oxygen species. Glaucoma is the second leading cause of blindness globally, accounting for 12.3% of the total blindness. Glaucoma has been broadly classified as primary or secondary open-angle or angle-closure glaucoma. The primary goal in management of glaucoma is to prevent the risk factor, especially elevated intraocular pressure (IOP), using medications, laser therapy or conventional surgery. The first-line treatment of glaucoma usually begins with the use of a topical selective or nonselective blocker or a prostaglandin analog. Second-line drugs of choice include alpha-agonists and topical carbonic anhydrase inhibitors. Cholinergic agonists are considered third-line treatment options. When a single therapy is not sufficient to lower the IOP, a combination therapy is indicated. To enhance the patient compliance, drug delivery systems like electronic devices, ocular inserts, tansdermal and mechanical drug delivery systems have been developed. Use of viscoelastic agents in ophthalmic formulations, emulsions and soluble ophthalmic drug inserts (SODI) enhance patience compliance and ocular drug delivery in patients in long-term glaucoma therapy. For patients who do not respond to antiglaucoma medications, laser trabeculoplasty and incisional surgery are recommended. Several nutrients and botanicals hold promise for the treatment of glaucoma, but most studies are preliminary, and larger, controlled studies are required. Future directions for the development of a novel therapy glaucoma may target glutamate inhibition, NMDA receptor blockade, exogenously applied neurotrophins, open channel blockers, antioxidants, protease inhibitors and gene therapy.
Highlights
Glaucoma is characterized by slow progressive degeneration of the retinal ganglion cells (RGCs) and the optic nerve axons, leading to increasing deterioration of the visual field
Glaucoma represents a common pathway for different eye conditions, many of which are associated with elevated intraocular pressure (IOP)
Risk factors for the development of glaucoma increased intraocular pressure is the major risk factor for primary open angle glaucoma (POAG), other factors such as increased glutamate levels, alterations in nitric oxide (NO) metabolism, vascular alterations and oxidative damage caused by reactive oxygen species[6] are involved [Table 1]
Summary
Glaucoma is characterized by slow progressive degeneration of the retinal ganglion cells (RGCs) and the optic nerve axons, leading to increasing deterioration of the visual field. It is estimated that about 66.8 million people have visual impairment from glaucoma, with 6.7 million suffering from blindness. Two percent of the population older than 40 years of age and five to nine percent of those older than 65 years have glaucoma.[3,4] It is estimated that there will be 60.5 million people with OAG (open angle glaucoma) and ACG (angle closure glaucoma) in 2010, which will increase to 79.6 million by 2020. Risk factors for the development of glaucoma increased intraocular pressure is the major risk factor for primary open angle glaucoma (POAG), other factors such as increased glutamate levels, alterations in nitric oxide (NO) metabolism, vascular alterations and oxidative damage caused by reactive oxygen species[6] are involved [Table 1]
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