Progressive Optic Neuropathy Research Articles

Glaucoma and Helicobacter pylori: Eyes wide shut?

Helicobacter pylori infection is worldwide spread disease with definite morbidity and mortality [1]. Besides different gastrouodenal diseases, this infection has been significantly associated ith both idiopathic thrombocypenic purpora and idiopathic iron eficiency anaemia [1]. Moreover, a possible pathogenetic role of . pylori has been hypothesised also in different extra-digestive isorders, including glaucoma. This is a serious ocular disease charcterised by a progressive optic neuropathy mainly due to a raised ntraocular pressure (IOP) [2]. Unfortunately, the causes of priary open-angle glaucoma (POAG) – the most common form of laucoma – are still unclear. There aremillions of peoplewith glauoma worldwide, and such a disease is the second most common auseof blindness [2]. Therefore, anynewfindingwhichpotentially nravels its aetiology is welcoming. In the last decade, H. pylori nfection has been claimed as a factor causing POAG, and an intersting review focused on such a field has been recently published 3]. Basically, the main conclusion was that, because of the coexisence of both positive and negative data on the correlation between he two diseases, further studies are needed [3]. We agree that furher investigations are needed, especially when considering that he available data come from studies with potential drawbacks. n detail, here we discuss data on: (1) infection prevalence; (2) athogenetic mechanisms; and (3) clinical relevance. As far as the infection seroprevalence is concerned, we failed o demonstrate a significant difference between glaucoma patients nd controls by pooling data of 6 available studies (Table 1) [4–9]. herefore the association – if any – seems to be weak. Moreover,H. ylori serological assessment presents at least 2 limitations: (a) it s not highly accurate so that its use is not advised in some guideines [1]; (b) it does not distinguish between active and previous nfection. For clinical purposes, we need to knowwhether an active nfection is present in order to evaluate modifications following herapy (see below). All these aspects need to be considered, espeially when only a small sample size is included, as occurs in the ajority of available studies (Table 1). To our knowledge, there are nly 2 studies – by the same investigator team – showing a signifcantly higher H. pylori prevalence assessed by either histology or

Ophthalmic Drug Delivery in Glaucoma—A Review

Glaucoma is a progressive optic neuropathy and medical therapy is the initial option for the treatment of this potentially blinding condition. Topical instillation of eye drops from the bottle is the most common glaucoma drug delivery form. Due to limited permeability of anterior ocular surface, natural clearance and drainage, eye drops contain large amounts of inactive ingredients. Effective penetration enhancers are known as irritants causing ocular discomfort. Although drug efficacy is determined by active ingredients, inactive agents can affect tolerance and can result in conjunctival irritation and hyperemia and influence patients’ adherence and quality of life.

Progressive optic neuropathy caused by contact with the carotid artery: Improvement after microvascular decompression

Department of Neurosurgery, NYU Langone Medical Center, 462 First Avenue, Room 7S4, New York, NY 10016, United States Department of Neurology, NYU Langone Medical Center, 462 First Avenue, Room 7S4, New York, NY 10016, United States Department of Ophthalmology, NYU Langone Medical Center, 462 First Avenue, Room 7S4, New York, NY 10016, United States Department of Radiology, NYU Langone Medical Center, 462 First Avenue, Room 7S4, New York, NY 10016, United States

Driving habits in glaucoma patients

Glaucoma is a progressive optic neuropathy leading to loss of visual function beginning with the peripheral visual field. One large population-based study found that individuals with visual impairment reported difficulties in performing most vision-dependent daily activities, including difficulty with driving. The objective of this retrospective cohort study was to investigate the driving habits of glaucoma patients and to determine the conformance of their visual acuity and visual fields with driving regulations. The charts of 20 patients followed in the Ophthalmology Department of Foch Hospital, Suresnes, Paris, France, with open angle glaucoma (mean visual field mean deviation of the worse eye: -15.5 dB; range -1.97 to -27 dB) and still driving, were reviewed. Data collected included visual acuity, type of glaucoma, slit lamp and fundus examination, most recent standard automated perimetry, and binocular visual field test results. Each patient was asked if he or she still drove on highways, and if he or she still drove at night. The driving habits of glaucoma patients were analyzed, and visual acuity and binocular visual fields were compared to French and European legal driving criteria. Thirteen patients (65%) with glaucoma were still driving on highways, and five (25%) at night. Seven patients (35%) were below French legal minimum visual acuity or visual field criteria. Glaucoma patients appear to self-regulate their driving habits by avoiding potentially difficult driving situations. Further studies with larger sample size are necessary to determine relationships between severity of visual impairment, severity of visual field defects, and the cessation of driving.

GALC Deletions Increase the Risk of Primary Open-Angle Glaucoma: The Role of Mendelian Variants in Complex Disease

DNA copy number variants (CNVs) have been reported in many human diseases including autism and schizophrenia. Primary Open Angle Glaucoma (POAG) is a complex adult-onset disorder characterized by progressive optic neuropathy and vision loss. Previous studies have identified rare CNVs in POAG; however, their low frequencies prevented formal association testing. We present here the association between POAG risk and a heterozygous deletion in the galactosylceramidase gene (GALC). This CNV was initially identified in a dataset containing 71 Caucasian POAG cases and 478 ethnically matched controls obtained from dbGAP (study accession phs000126.v1.p1.) (p = 0.017, fisher's exact test). It was validated with array comparative genomic hybridization (arrayCGH) and realtime PCR, and replicated in an independent POAG dataset containing 959 cases and 1852 controls (p = 0.021, OR (odds ratio) = 3.5, 95% CI −1.1–12.0). Evidence for association was strengthened when the discovery and replication datasets were combined (p = 0.002; OR = 5.0, 95% CI 1.6–16.4). Several deletions with different endpoints were identified by array CGH of POAG patients. Homozygous deletions that eliminate GALC enzymatic activity cause Krabbe disease, a recessive Mendelian disorder of childhood displaying bilateral optic neuropathy and vision loss. Our findings suggest that heterozygous deletions that reduce GALC activity are a novel mechanism increasing risk of POAG. This is the first report of a statistically-significant association of a CNV with POAG risk, contributing to a growing body of evidence that CNVs play an important role in complex, inherited disorders. Our findings suggest an attractive biomarker and potential therapeutic target for patients with this form of POAG.

Silicone punctal plugs as an adjunctive therapy for open‐angle glaucoma and ocular hypertension

Background: Primary open‐angle glaucoma is a progressive optic neuropathy that can cause an irreversible loss of vision. A reduction in intraocular pressure (IOP) is beneficial in slowing or halting its progression. Once‐per‐day monotherapy glaucoma medications, such as prostaglandin analogues, are effective in lowering IOP while maintaining patients' adherence. Achieving the desired target IOP often requires multiple medications. The present study evaluates punctal occlusion of both the inferior and superior puncta as an adjunctive therapy to travoprost ophthalmic solution 0.004% for patients with primary open‐angle glaucoma or ocular hypertension in order to reduce IOP.Methods: Thirteen patients who were using travoprost 0.004% ophthalmic solution for the treatment of open‐angle glaucoma or ocular hypertension received silicone punctal plugs in the superior and inferior puncta of one eye. After one month, the IOP was remeasured. The percentage change of the IOP from the baseline was analysed by using a paired sample t‐test.Results: The mean baseline IOP was 19.82 ± 1.19-mmHg in the test eyes and 18.32 ± 1.11-mmHg in the control eyes. The mean IOP at the one‐month visit was 18.23 ± 1.17-mmHg in the test eyes and 18.45 ± 1.04-mmHg in the control eyes. The test eyes demonstrated a decrease in IOP of 1.59 (± 0.95) mmHg from the baseline, or a 6.82 per cent decrease in the IOP from the baseline. The control eyes had an increase in IOP of 0.14 ± 0.77-mmHg from the baseline, or a 1.91 per cent increase in the IOP. The relative difference in the IOP between the test eyes and the control eyes at the one‐month visit was 1.73-mmHg, or 8.74 per cent.Conclusion: Based on the results of this study, punctal occlusion offers a statistically and clinically significant decrease in IOP when it is used as an adjunctive therapy to travoprost 0.004% for patients who are suffering from open‐angle glaucoma or ocular hypertension.

Biomarkers and special features of oxidative stress in the anterior segment of the eye linked to lens cataract and the trabecular meshwork injury in primary open‐angle glaucoma: challenges of dual combination therapy with N‐acetylcarnosine lubricant eye drops and oral formulation of nonhydrolyzed carnosine

The implication of oxidative stress associated with increased oxidant production in mammalian and human cells characterized by the release of free radicals, resulting in cellular degeneration, is involved in many ocular diseases, such as age-related macular degeneration, retinopathy of prematurity, retinal light damage, primary open-angle glaucoma (POAG), and cataract. Cataract is the leading cause of blindness, accounting for 50% of blindness worldwide. Glaucoma, the leading cause of irreversible blindness, is considered as a progressive optic neuropathy often caused by elevated intraocular pressure (IOP) consequent to abnormally high resistance to aqueous humor (AH) drainage via the trabecular meshwork (TM) and Schlemm's canal. Morphological and biochemical analyses of the TM of patients with POAG revealed the loss of cells, increased accumulation of extracellular matrix proteins (ECM), changes in the cytoskeleton, cellular senescence, and the process of subclinical inflammation. The TM is the target tissue of glaucoma in the anterior chamber, and the development and progression of glaucoma are accompanied by the accumulation of oxidative damage in this tissue. The separate studies were conducted to comparatively evaluate the sensitivity to oxidative stress and lipid peroxidation (LPO) of anterior chamber tissues including TM. Accumulation of the primary, secondary, and end products of LPO (diene and triene conjugates, Schiff's bases) was noted in the studied extracts. Significant differences in the levels of all mentioned LPO products in comparison with the control were observed. The data may be considered as an evidence of LPO participation in the destruction of the trabecule and Schlemm's canal in POAG. Treatment of TM cells with oxidative stress induced POAG-typical changes such as ECM accumulation, cell death, disarrangement of the cytoskeleton, advanced senescence, and the release of inflammatory markers. By pretreatment with antioxidants, prostaglandin analogs, beta-blockers, or local carbonic anhydrase inhibitors, these effects were markedly reduced. Oxidative stress can induce characteristic glaucomatous TM changes, and these oxidative stress-induced TM changes can be minimized by the use of antioxidants and IOP-lowering substances. It is tempting to speculate that the prevention of oxidative stress exposure to the TM may help to reduce the progression of POAG. The author's laboratory has developed and patented the dual combination therapy with N-acetylcarnosine lubricant eye drops and oral formulation of nonhydrolyzed carnosine in ripe cataracts and POAG. The specific regimen for the treatment in each stage of age-related ophthalmic disease has been taken up. In the treatment of POAG, this dual therapy can be combined with conventional antiglaucoma therapy with beta-blocking and/or adrenergic agonist medicines providing the significant IOP-lowering effect and significant increase in outflow facility. The developed therapy is a prominent management care of the glaucomatous neurodegeneration.

Specific deficits in visual electrophysiology in a mouse model of dominant optic atrophy

Autosomal dominant optic atrophy (ADOA) is a slowly progressive optic neuropathy caused by mutations in the OPA1 gene. OPA1 is ubiquitously expressed and plays a key role in mitochondrial fusion. Heterozygous Opa1 mutant mice (B6; C3-Opa1Q285STOP), have previously been reported to develop visual defects and optic nerve changes. In this study, in vivo visual electrophysiological testing (ERGs and VEPs) was performed on 11–13 month old B6; C3-Opa1Q285STOP mice (n = 5) and age/sex matched wildtype littermate controls. Full intensity series were recorded in response to brief (4 ms) single flash stimuli delivered in a Ganzfeld dome under dark- and light-adapted conditions. The major ERG components (a-wave and b-wave) showed no detectable difference from wildtype in the amplitude or implicit time of dark-adapted ERGs across the full intensity range tested. This was also true for the components of the dark-adapted VEP. However, the light-adapted ERG responses revealed a significant reduction in the photopic negative response (PhNR) amplitude in Opa1+/− animals relative to wildtypes at the brighter intensities tested. Elements of the light-adapted VEP were also abnormal in mutant mice. Overall Opa1+/− mice display functional deficits in electrophysiology that are consistent with ganglion cell dysfunction. These deficits may correlate with a reduction in the dendritic arborisation of retinal ganglion cells, which has been previously reported to occur at a similar age in the same mutant mouse line (Williams et al., 2010). The functional phenotype we have described in this mouse model may be useful in the robust and accurate assessment of potential treatments for ADOA.

Are intracranial pressure fluctuations important in glaucoma?

Glaucoma is one of the leading causes of irreversible blindness. Primary open-angle glaucoma (POAG), the most common type, is a progressive optic neuropathy with characteristic structural changes in the optic nerve head and functional changes in the visual field. Mechanical and vascular theories for the pathogenesis of glaucomatous optic neuropathy have been proposed. Elevated intraocular pressure (IOP) is a strong risk factor, although a subset of POAG patients has normal IOP and is designated normal tension glaucoma (NTG). Clearly, factors other than IOP are likely to be involved in retinal ganglion cell death in glaucoma. An intriguing finding of recent studies is that intracranial pressure (ICP) is lower in patients with POAG and NTG when compared with nonglaucomatous control subjects. It has been suggested that the relationship between IOP and ICP may play a fundamental role in the development of glaucoma. A decreased ICP could result in an increased trans-lamina cribrosa pressure difference (IOP minus ICP) and lead to glaucomatous damage. In the present paper, we raise the question of whether ICP fluctuations also may be important in glaucoma. The effect of ICP fluctuation might be comparable to that of IOP fluctuation, which has been recognized as an independent risk factor for glaucoma progression.

597 ATHEROGENIC SUBFRACTIONAL BLOOD LIPOPROTEINS PROFILE AND ITS GENETIC MARKERS IN WEST SIBERIA

Glaucoma is a progressive optic neuropathy and is one of the leading causes of blindness in the industrialized countries. The aim of this study is to investigate microRNA (miRNA) regulation in glaucoma and other neurodegenerative diseases, that share similar pathways, by means of in silico approaches such as bibliographic search and access to bioinformatic resources. First of all, data mining was carried out on Human miRNA Disease Database (HMDD) and miR2Disease databases. Then, predictions of deregulated miRNAs were carried out accessing to microrna.org database. Finally, the potential combinatorial effect of miRNAs, on regulation of biochemical pathways, was studied by an enrichment analysis performed by DIANA-miRPath v.2.0. We found, from literature search, 8 deregulated miRNAs in glaucoma and 9 and 23 in age-related macular degeneration (AMD) and Alzheimer's disease (AD), respectively. One miRNA is commonly deregulated in glaucoma and AMD (miR-23a). Two miRNAs (miR-29a, miR-29b) are common to glaucoma and AD, and four miRNAs were identified to be commonly deregulated in AMD and AD (miR-9, miR-21, miR-34a, miR-146a). The match of the miRNA common to glaucoma and the other two neurodegenerative diseases (AMD and AD) did not generate any output. Enrichment of information has been reached through miRNAs prediction: 88 predicted miRNAs are common to glaucoma and AMD, 19 are common to glaucoma and AD, and 9 are common to AMD and AD. Indeed, predicted miRNAs common to the three neurodegenerative diseases are nine (miR-107, miR-137, miR-146a, miR-181c, miR-197, miR-21, miR-22, miR-590, miR-9). DIANA-miRPath predicted that those nine miRNAs might regulate pathways involved in inflammation. The findings hereby obtained provide a valuable hint to assess deregulation of specific miRNA, as potential biomarkers and therapeutic targets, in glaucoma and other neurodegenerative diseases by means of preclinical and clinical studies.

Depression, anxiety and prolonged sleep latency in glaucoma: Evidence for circadian alteration?

Glaucoma is a chronic, progressive optic neuropathy [1]. Excessive retinal oxidative stress is considered a major pathophysiological pathway leading to glaucomatous alterations, visual field defects (VFD) and neurodegeneration with progressive loss of the retinal ganglion cells (RGC) and herewith to an affected light transmission to the suprachiasmatic nucleus (SCN) [2, 3]. Progressed glaucoma has been therefore lately suggested to be the main ophthalmologic disease affecting the photic input to the circadian system, leading to an impairment of the photo-dependent melatonin production and to an affection of the circadian rhythm and thus to several physiological consequences, including sleep and affective disorders [4]. However, with respect to depression and sleep disturbance, study results are sparse and contradictory [5, 6]. The objective of this study is the investigation of the prevalence and specific psychopathology of sleep disorders, depressive and anxiety symptoms among glaucoma patients with and without VFD. Herewith, the correlation between visual impairment, circadian disarrangement and depression should be further explored.

Long-Term Outcomes of Selective Laser Trabeculoplasty (SLT) Treatment

Purpose:Glaucoma is a progressive optic neuropathy that may lead to blindness. Reducing intraocular pressure (IOP) seems to be the only treatment that slows progression in glaucoma. IOP can be decreased by pharmaceutical treatment, laser treatment or surgery.The aim of the present study was to assess the long-term efficacy of selective laser trabeculoplasty (SLT) treatment. Methods:Retrospective chart review of eyes that underwent SLT between 1 January 2005 and 31 December 2005. The primary outcome measure was time to failure after SLT treatment. Failure after SLT was defined as any one or more of the following: change in the medical treatment, performance of a further SLT treatment, the patient being sent for surgery. All patients were treated over 90° with SLT.Results:120 eyes of 120 patients were identified. The average time to failure after SLT was 18 months. The success rate after 12 months was 62%, after 24 months 34%, after 36 months 28% and after 48 months 24%.Conclusions:The long-term effects of SLT when eyes were treated over 90° seem to be low. The authors recommend treating patients over 180°, as has traditionally been done. We suggest that this will improve the long-term results.

Vascular risk factors in glaucoma: a review

Glaucoma, one of the major causes of blindness in the world, is a progressive optic neuropathy. Elevated intraocular pressure is a well-known major risk factor for glaucoma. In addition, there is growing evidence that vascular factors may play a role in glaucoma pathogenesis. Systemic (e.g. hypertension, diabetes) and ocular vascular factors (e.g. ocular blood flow, ocular perfusion pressure) have been assessed for associations with glaucoma. However, direct and convincing evidence for primary mechanisms of glaucoma is still lacking. The aim of this review is to summarize the evidence implicating vascular factors in the pathogenesis of glaucoma, with particular emphasis on the role of ocular blood flow and ocular circulation as risk factors for primary open angle glaucoma.

Automated alternation flicker for the detection of optic disc haemorrhages

Optic disc haemorrhages are associated with active glaucomatous neurodegeneration and ongoing visual field loss. We sought to determine whether automated alternation flicker enhances the detection of disc haemorrhages in serial images from patients with glaucoma when compared to side-by-side photographic evaluation and single-image display. Serial sets of optic nerve photographs of 394 eyes from 234 patients followed for glaucoma at the authors' institutions were included in this study. Eyes with disc haemorrhages were graded for difficulty level and randomized along with nondisc haemorrhage control images into one of three presentation groups (automated alternation flicker, side-by-side or single image). Seven graders viewed all images and assessed for the presence or absence of disc haemorrhages. The sensitivity of automated alternation flicker for disc haemorrhage detection (0.878) was higher than side-by-side (0.705; p = 0.002) and single photographs (0.757; p = 0.01). There was no specificity difference between pairs of presentation groups (all p ≥ 0.7). Automated alternation flicker was a more sensitive method for disc haemorrhage detection than the current clinical standards and may have an important role in the management of glaucoma.

Is normal-tension glaucoma different from primary open-angle glaucoma

Based on the clinical consideration, Chinese glaucoma specialist reached a consensus (2008) that normal-tension glaucoma (NTG) is a subtype of primary open-angle glaucoma (POAG), and the dividing line is whether the intraocular pressure (IOP) more than 21 mm Hg or not. But it is still a controversial problem in the world that whether NTG is different from POAG or not. Some studies have confirmed that the pathogenesis of optic neuropathy, clinical features, risk factors for glaucomatous optic neuropathy progression and treatment strategy in NTG are different from those of POAG, indicating that they may be two different disorders.

Validation of the Glaucoma Filtration Surgical Mouse Model for Antifibrotic Drug Evaluation

Glaucoma is a progressive optic neuropathy, which, if left untreated, leads to blindness. The most common and most modifiable risk factor in glaucoma is elevated intraocular pressure (IOP), which can be managed surgically by filtration surgery. The postoperative subconjunctival scarring response, however, remains the major obstacle to achieving long-term surgical success. Antiproliferatives such as mitomycin C are commonly used to prevent postoperative scarring. Efficacy of these agents has been tested extensively on monkey and rabbit models of glaucoma filtration surgery. As these models have inherent limitations, we have developed a model of glaucoma filtration surgery in the mouse. We show, for the first time, that the mouse model typically scarred within 14 d, but when augmented with mitomycin C, more animals maintained lower intraocular pressures for a longer period of time concomitant with prolonged bleb survival to beyond 28 d. The morphology of the blebs following mitomycin C treatment also resembled well-documented clinical observations, thus confirming the validity and clinical relevance of this model. We demonstrate that the antiscarring response to mitomycin C is likely to be due to its effects on conjunctival fibroblast proliferation, apoptosis and collagen deposition and the suppression of inflammation. Indeed, we verified some of these properties on mouse conjunctival fibroblasts cultured in vitro. These data support the suitability of this mouse model for studying the wound healing response in glaucoma filtration surgery, and as a potentially useful tool for the in vivo evaluation of antifibrotic therapeutics in the eye.

Predictive factors of success in selective laser trabeculoplasty (SLT) treatment

Purpose:Glaucoma is a progressive optic neuropathy that may lead to blindness. Reducing intraocular pressure (IOP) is the only known treatment to slow progression in glaucoma. IOP can be reduced by pharmaceutical treatment, laser and surgery. The aim of the present study was to assess predictive factors of success after selective laser trabeculoplasty (SLT) treatment.Methods:We used a retrospective chart review of eyes that underwent SLT between January 1, 2005 and December 31, 2005. The dependent variable was time to failure after SLT treatment. Failure after SLT was defined as any changes in the medical treatment, and/or a new SLT treatment was performed and/or the patient was sent for surgery. All patients were treated with 90° SLT. A multivariate regression analysis was performed to assess correlation between time to failure after SLT and age, gender, IOP before treatment, number of medications used, SLT number, amount of spots, laser energy used, grade of angle, pigmentation and diagnosis.Results:120 eyes of 120 patients were identified. The average time to failure after SLT was 18 months. The predictive factors identified were: age, IOP before SLT and dose.Conclusion:Predictive factors identified in our study were high baseline IOP, age and amount of laser energy used. Our study confirms previous results about baseline IOP as a predictive factor.

Optic disc topography in normal Indian eyes using spectral domain optical coherence tomography

Purpose:The aim was to study optic nerve head (ONH) parameters in normal Indian eyes using spectral domain optical coherence tomography (OCT)/scanning laser ophthamoscope (SLO).Materials and Methods:One hundred and fifty-seven eyes of 157 normal subjects of various age groups underwent ONH imaging with spectral OCT/SLO and the parameters obtained were correlated with disc size. The effect of age, gender, and refractive error on various ONH parameters were also studied.Results:The mean optic disc area was 3.36 ± 0.64 mm2 (range, 2.13–5.08 mm2), mean rim area was 2.49 ± 0.58 mm2 (range, 1.20–3.62 mm2), and mean cup area was 1.10 ± 0.75 mm2 (range, 0–3.07 mm2). The disc area showed significant positive correlation with the rim area, cup area, horizontal cup disc ratio, vertical cup disc ratio, cup disc area ratio, mean cup depth, and maximum cup depth (P < 0.001). Neither gender nor refractive error showed any significant difference in various ONH parameters. ONH parameters did not show significant change with age except for rim area which declined with the advancing age (r = –0.25, P < 0.001).Conclusions:The quantitative measurement of ONH topography obtained with this study provides a normative database for an Indian population with spectral OCT/SLO. As optic disc area influences ONH topography, disc size should to be considered when evaluating optic disc for progressive optic neuropathies such as glaucoma.

The unique problem of glaucoma: Under-diagnosis and over-treatment

The unique problem of glaucoma: Under-diagnosis and over-treatment

Aplicaciones de los cannabinoides en glaucoma

Introduction Glaucoma is a slowly progressive optic neuropathy that is one of the leading causes of legal blindness throughout the world. Currently there is a limited group of topical drugs for the medical treatment of glaucoma is currently limited, and research needs to be focused on new therapeutic horizons, such as the potential usefulness of the cannabinoid agonists for the treatment of glaucoma. Aim To review the current scientific literature related to the beneficial effects derived from the different ways of administration of cannabinoids indicated for the glaucomatous optic neuropathy. Development Cannabinoid receptors have shown an intense expression in ocular tissues implicated in the regulation of the intraocular pressure, as well as inner layers of the retina. Through activation of CB1 and CB1 specific receptors and through other still unknown pathways, the cannabinoid agonists have shown both a clear hypotensive, as well as an experimentally proved neuroprotective effect on retinal ganglion cells. Conclusions Some cannabinoid agonists (WIN 55212-2, anandamide) have demonstrated, in experimental studies, to act as «ideal drugs» in the management of glaucoma, as they have been shown to have good tolerability after topical application, efficiently reduce intraocular pressure, and behave as neuroprotectors on retinal ganglion cells. Further studies as regards the safety and clinical assays must be carried out in order to examine the effectiveness of these drugs for the treatment of glaucoma in our daily clinical practice.