THE NERVE OF GLAUCOMA

Contemporary concepts of open angle glaucoma suggest that the current emphasis on reduction of elevated intraocular pressure could be augmen ted by other therapeutic approaches. In this article, we describe sign ificant recent developments in the molecular and cellular biology and neuropharmacology of nerve damage that are likely, in coming years, to suggest new therapeutic approaches to the management of glaucoma. The se developments may lead to the achievement of pharmacologic protectio n of the optic nerve from damage or possibly promotion of reversal of damage. We review selected studies of excitotoxins and N-methyl-D-aspa rtate receptor antagonists, Ca2+-induced damage and calcium channel bl ockers, the intracellular messenger nitric oxide and its perturbation, free-radical damage and scavengers, nerve regeneration, and growth fa ctors. Several basic research questions are posed, answers to which ma y transform our concepts of glaucoma therapy.