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Editors Selection IGR 20-3

Medical Therapy: Donepezil in NTG

Comment by Leopold Schmetterer on:

25832 A pilot study for the effects of donepezil therapy on cerebral and optic nerve head blood flow, visual field defect in normal-tension glaucoma, Yoshida Y; Sugiyama T; Utsunomiya K et al., Journal of Ocular Pharmacology and Therapeutics, 2010; 26: 187-192

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Donepezil, a cholinesterase inhibitor, is approved to treat symptoms in people with Alzheimer's disease. It is assumed to enhance the action of acetylcholine by making the receptors it interacts with more responsive. Yoshida et al. (900) performed a pilot study in seven patients with normal tension glaucoma (NTG) showing reduced cerebral blood flow as assessed with 123 I-iodoamphetamine single photon emission computed tomography. In an open pilot study the effect of 12 months treatment with 5 mg/day donepezil hydrochloride on cerebral and ocular perfusion parameters and visual fields was studied. Two patients were not included in analysis because of either discontinuation of donepezil therapy (n = 1) or unreliable visual field testing (n = 1). In the remaining five patients improvements in visual fields of more than 2 dB were found in two patients, whereas the visual fields remained stable in the other three patients. The drug did not affect intraocular pressure. Optic nerve head blood flow as assessed with laser speckle technique and cerebral blood flow did not change after the 12 months treatment period. Given the similarities between the mechanisms of neuronal cell death in Alzheimer's disease and glaucoma it may be attractive to study the potential of donepezil as an antiglaucomatous treatment. In the present study an improvement of visual fields was seen in two out of five patients. One needs, however, to keep in mind that the study did not follow a controlled or randomized design. The data obtained in this trial may provide a rationale for setting up randomized placebo-controlled trials investigating the effect of donepezil therapy on glaucoma progression.

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