New glaucoma therapy is neuroprotection. Similarity to stroke, Alzheimer’s disease, Parkinson’s diseases. 3

Glaucoma new treatment approach is based on neuroprotection. It is the same as treatment methods in other brain degenerative diseases. Alzheimer’s disease or Parkinson’s disease.

Glaucoma, silent eye disease, needs a very careful screening. Glaucoma correct diagnosis requires interpretation of several eye tests. Dr. Anton Titov, MD. What is the latest trends in glaucoma treatment? Where glaucoma treatment field is going? What might be available for patients with glaucoma in the near future? What might not be available now. Or some glaucoma treatments are at a research stage? Dr. Francesca Cordeiro, MD. For the last 15 – 20 years patients have been looking at new methods of preventing deterioration in vision. New diagnostic tests also appeared in neurodegenerative diseases. We’ve been much interested in things called neuroprotective agents. Neuroprotection is accepted in diseases such as Alzheimer’s disease. Neuroprotection exists for Parkinson’s disease and brain stroke. It means a treatment prevents your nerve cells dying. In glaucoma, the nerve cells that you are preventing from dying are the retinal ganglion cells. Interestingly, the same methods that you apply to any neurodegeneration work in glaucoma. Any lessons from brain disease, such as Alzheimer’s disease or Parkinson’s disease, can be applied to glaucoma. We have borrowed many therapies for brain neurodegenerative diseases. We applied them in glaucoma. Dr. Francesca Cordeiro, MD. One of the things that is different from glaucoma. In Alzheimer’s disease or Parkinson’s diseases it does not exists. But in glaucoma you have the added factor of the increased pressure in the eye. The reason why patients think that “glaucoma is increased eye pressure” is this. All of our treatments are aimed at lowering the pressure in the eye. That is how we treated in glaucoma. That in itself is probably more of a protective therapy. But we don’t call it protection. We call it “treatments to lower the pressure in the eye”. Now, one thing that has been a problem is this. Because we have this very good treatment. Establishing other treatments that don’t work by decreasing eye pressure is difficult. Dr. Francesca Cordeiro, MD. We’ve only had two large scale clinical trials of neuroprotective agents in glaucoma. One of them came from the world of Alzheimer’s disease. This is memantine. Memantine is an NMDA antagonist. It stops the cell from dying through stopping it getting excited. Memantine stops cells from being hyperexcited. So, this medication is a tablet. This was tried in a very large scale trial about 2,000 patients back in the 2000s. One of the problems with that particular trial is the pharmaceutical company that did the clinical trial never published the results. All that exists is a press release. It suggests that the trial was not successful. In other words, memantine wasn’t shown to prevent glaucoma. There was a lot of controversy about test results. Dr. Anton Titov, MD. Why memantine did not work in glaucoma? But we’ve learned a lot about the glaucoma clinical trial results. Even without results being published. We have to rely on patients who took part in the clinical trial. That usually are patients who are investigators in the trial. It was probably the same issues that Alzheimer’s disease and Parkinson’s disease clinical trials used to have. They didn’t really have a defined population of patients. Patients were at different stages of the eye disease. The investigators were allowed to make up their minds as to whether patients needed further therapy treatments. Dr. Francesca Cordeiro, MD. So it was all a mixed result. We could explain probably that. Dr. Anton Titov, MD. Perhaps the glaucoma neurodegeneration therapy results weren’t clear because there was a mixture of different degrees of glaucoma eye disease.