Neuroprotection for treatment of glaucoma in adults

Sena DF, Ramchand K, Lindsley K

Published Online:

February 17, 2010

Glaucoma is a leading cause of blindness worldwide. It is classified as a group of conditions characterized by progressive damage to the optic nerve, deterioration of retinal ganglion cells and ultimately visual field loss. With regards to glaucoma, neuroprotection refers to any intervention intended to prevent optic nerve damage or cell death. The rationale for treatment is that by acting as pharmacological antagonists, neuroprotective agents will prevent optic nerve damage and cell death, thus preserving vision in patients with glaucoma. The purpose of this review was to examine the evidence for the effectiveness of neuroprotection for glaucoma. No relevant studies were identified, although short-term trials and other studies are discussed. At present there is insufficient evidence to conclude whether neuroprotective agents are effective for the treatment of glaucoma.

Abstract (click to read)

Background:

Glaucoma is a heterogeneous group of conditions involving progressive damage to the optic nerve, deterioration of retinal ganglion cells and ultimately visual field loss. It is a leading cause of blindness worldwide. Open angle glaucoma (OAG), the commonest form of glaucoma, is a chronic condition that may or may not present with increased intraocular pressure (IOP). Neuroprotection for glaucoma refers to any intervention intended to prevent optic nerve damage or cell death. The treatment can target extracellular factors such as reducing IOP, or cellular factors derived from the optic nerve itself such as blocking intracellular death signals.

Objectives:

The objective of this review was to systematically examine the evidence regarding the effectiveness of neuroprotective agents, either topical or oral, for slowing the progression of OAG in adults.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, Issue 4, 2009), MEDLINE (January 1960 to January 2010), EMBASE (January 1980 to January 2010), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2010) and ClinicalTrials.gov (http://clinicaltrials.gov). (5 January 2010). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 5 January 2010.

Selection criteria:

This review was limited to randomized controlled trials (RCTs) in which topical or oral treatments were used to prevent retinal ganglion cell death. Our population of interest was adults with OAG. As the primary outcome for this review was the proportion of participants who developed any progression of visual field loss at five years post intervention, only trials with at least five years of follow-up were included.

Data collection and analysis:

Two review authors independently reviewed titles and abstracts from the literature searches. Full text copies of relevant or potentially relevant studies were obtained and re-evaluated for inclusion. There were no trials identified for this review, thus we performed no data extraction or meta-analysis. Two studies comparing memantine to placebo are currently awaiting classification until additional study details are provided. Reasons for excluding studies from the review were documented.

Main results:

In accordance with the selection criteria for inclusion, we identified no studies relevant for this review. The results of short-term trials and other studies are discussed in this review.

Authors' conclusions:

Although neuroprotective agents are intended to act as pharmacological antagonists to prevent cell death, the evidence that they are effective in preventing retinal ganglion cell death, and thus preserving vision in patients with OAG, has not been demonstrated. Long-term RCTs are needed to determine whether or not neuroprotective agents may be beneficial for individuals with OAG.

This record should be cited as:

Sena DF, Ramchand K, Lindsley K. Neuroprotection for treatment of glaucoma in adults. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD006539. DOI: 10.1002/14651858.CD006539.pub2

Assessed as up to date:

January 5, 2010

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Primary Review Group:

Eyes and Vision Group

Health topics:

Eyes & vision > Glaucoma > Open angle

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Neuroprotection for treatment of glaucoma in adults

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