Glaucoma PhysicianNeuroprotection in Glaucoma

Despite a century of IOP-lowering therapy, too many glaucoma patients still go blind or suffer profound quality-of-life loss. Three emerging neuroprotective strategies targeting ganglion cells, axons, and vascular support may finally change that trajectory.

🔬 Clinical Considerations

• DLK/LZK pathway inhibition provided near-complete ganglion cell protection at pressures of 50 to 60 mmHg in nonhuman primates over 30 days
• SARM1 inhibition and NAD+ preservation block Wallerian degeneration distal to the lamina cribrosa, where IOP-lowering has no reach
• Endothelin antagonism targets optic nerve vascular support, with early signals showing improved visual field function and blood flow
• AI-enrichment strategies and trend-based progression analysis may shrink trial sizes from thousands to hundreds of patients

🎯 Practice Applications

• Counsel patients that IOP control, while essential, may not fully prevent progression
• Monitor fast progressors as candidates for emerging neuroprotective trials
• Track nicotinamide supplementation literature; human trial data are pending
• Follow Perceive Pharma and Perfuse Therapeutics pipelines for near-term clinical availability

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