Neuroprotection in glaucoma: old concepts, new ideas

Introduction: The disease process of glaucoma is thought to begin up to 20 years before a diagnosis can be made. While its current treatment paradigm seeks to reduce the rate of disease progression through reducing intraocular pressure, these interventions are of limited effectiveness and are typically made late. Together, this highlights an unmet clinical need for the development of novel techniques to facilitate the early diagnosis of glaucoma and the emergence of new treatment paradigms. This review provides a summary of recent developments in the early diagnosis and treatment of glaucoma, including updates on natural neuroprotective compounds. Areas covered: A systematic review of the literature was conducted including the keywords retinal ganglion cell apoptosis, neuroprotection, resveratrol, curcumin, adaptive optics, and detection of apoptosing retinal cells. Expert opinion: While a growing number of preclinical studies have reported the efficacy of neuroprotective interventions for the treatment of glaucoma, these technologies have not yet translated into clinical use. A likely explanation for this phenomenon is the relatively late stage at which glaucoma is currently diagnosed in patients. The development of techniques to diagnose glaucoma earlier in the disease process would enable the earlier administration of neuroprotective interventions which could slow glaucoma-associated vision loss.