Top-Ten of the International Ocular Neuroprotection Symposium

October 14, 2006, Toronto, Canada

Neeru Gupta

• Glaucoma neuroprotection may optimally be achieved by modulating pathological processes within ocular tissues and between the eye and brain, and may need to consider insults from co-morbid conditions and lifestyle choices.
• Glaucoma affects visual neurons in the eye and the brain, and future therapies directed at both retinal ganglion cells and their targets/connections in the lateral geniculate nucleus and visual cortex, may maximally protect against visual dysfunction and loss.
• The coming decade points to a major paradigm shift in treating glaucomatous disease, to include novel neuroprotective strategies aimed at visual neurons in addition to intraocular pressure lowering therapies to prevent blindness.
• Optimal candidates for neuroprotective glaucoma agents proven by randomized controlled clinical trials may include those with moderate to advanced glaucoma and visual field loss at risk for progression, and patients with progressive vision loss despite well-controlled intraocular pressure.
• A combination of structural and functional measures may help to assess neuroprotection in glaucoma patients, and may include novel in vivo real time survival assessment of retinal ganglion cell and central visual neurons.
• In low tension glaucoma, lowering intraocular pressure may not halt the glaucomatous process, and therapies toward mechanisms underlying neurodegenerative disorders may target shared pathways to help prevent vision loss in glaucoma.
• 'Encapsulated cell technology' is a novel method to deliver therapeutic proteins to the retina, showing promise in human phase 1 studies of retinal degenerations, and may be applicable to glaucoma through the delivery of neuroprotectants.
• A number of natural plant compounds including ginkgo biloba and cannabinoids show anti-apoptotic activities, and these compounds deserve further investigation regarding potential neuroprotective roles in glaucoma.
• Neuron survival in optic nerve injury models is regulated by specialized T cells, and immune based therapeutic strategies to exploit T cell activities may protect against neural injury in glaucoma.
• Drug delivery via cells and genes in the treatment of glaucoma over the next 5-10 years is predicted to embrace methods targeting the retina, including scleral permeable depots, implantable devices, and gene transfer technology to preserve visual neurons and prevent blindness.

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