Glaucoma is a painless eye disease that can lead to complete loss of vision if left untreated. It is possible to slow down its development by regularly monitoring its eye pressure. Eye drops, laser intervention, other drugs, and new therapeutic avenues focus on treatments to overcome glaucoma.
With glaucoma, eye pressure may be high. Indeed, it is regulated by aqueous humour, a liquid evacuated by the trabecula. Due to the disease, this flow no longer occurs, and the intraocular pressure increases. How to cure it?
In most cases, local treatment with eye drops or eye drops is sufficient to slow glaucoma progression by lowering eye pressure effectively. It is necessary to deposit the drops in the eyes daily. This treatment is to be taken for life. There are four different families:
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In May 2021, researchers at Karolinska Institutet and St. Erik Eye Hospital studied the effects of nicotinamide, a vitamin B3 compound, on animal and cellular models of glaucoma. These findings were published in Redox Biology. The first results could point to future neuroprotective therapy. A clinical trial will begin in the fall of 2021.
In previous studies, researchers identified that the NAD molecule declines in the retina in an age-dependent manner and makes retinal ganglion cells susceptible to neurodegeneration. Thus, the administration of nicotinamide would succeed in preventing the depletion of the molecule. Scientists have also found that elevation of NAD levels by administration of nicotinamide can improve visual function in patients with existing glaucoma.
“We have confirmed the neuroprotection of nicotinamide in cell models and additional animals which recapitulate isolated features of glaucoma, but which are also common neurodegenerative features. We have also developed sensitive tools to study the metabolism of NAD, and the metabolism of other essential metabolites, in the visual system,” explained study lead author James Tribble, a postdoctoral researcher in the Department of Clinical Neuroscience. The latter reports limited molecular side effects.
Painless and now minimally invasive, trabeculoplasty is increasingly used. Thanks to the selective laser (SLT), this operation can now be offered as a first-line treatment, particularly to young people whose optic nerve condition is worrying. It was offered as a last resort before surgery if the treatment with eye drops was not effective enough. The difficulties of adhering to the treatment of glaucoma, and its possible hazards, are now scanned with the laser. Two sessions for each eye improve the permeability of the trabecula for better evacuation of aqueous humour. An effective intervention for 2-3 years, after which the treatment can be repeated once.
If you cannot tolerate any eye drops, you can resort to swallowing medication (carbonic anhydrase inhibitor, Diamox ). This type of medicine can also be useful when eye pressure remains very high despite treatment with eye drops. It will allow the eye’s surface to rest and preserve the chances of success of a laser or surgical intervention.
Finally, if eye drops or laser treatment are intolerable or ineffective over time, surgery may be necessary. The surgeon may choose to perform a trabeculectomy or a sclerectomy. Each of these techniques aims to permanently lower eye pressure to stop the progression of the disease.
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