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Most modern antihypertensive drugs used in the treatment of primary open-angle glaucoma have an indirect neuroprotective effect not only because they reduce intraocular pressure (IOP), but also because of a stimulating effect on the natural metabolic processes in the eye. Researchers and clinicians today follow the strategy of compensating IOP, starting from the earliest stages of glaucomatous optic neuropathy (GON), regardless of which drug (generic or original) reduces IOP and which combination of the main active substances this drug has. The need for neuroprotective therapy in clinical practice mainly appears either in the far advanced stages or in cases of progressive loss of visual functions. However, given the multifactorial nature of GON, it is extremely important to add neuroprotective treatment in time, starting from the early stages. Electrophysiological and morphometric studies can provide objective monitoring of neuroprotective therapy. In order to increase the effectiveness of treatment, hypotensive therapy should be supplemented by early use of direct neuroprotectors targeted at oxidative stress, and excitotoxicity and affecting other molecular mechanisms of glaucoma so as the primary events of neurodegeneration could be blocked.

There is a constant search for new possibilities of the diagnosis of neurodegenerative diseases that cause dementia. The problem is important because of the growing prevalence of dementia, 60-80% of which are caused by Alzheimer's disease (AD). Over the last years, changes in the retina are thought to be a marker neurodegeneration. Assessment of these changes is performed using a method of optical coherent tomography (OCT) that allows taking cross-sectional imaging of a tissue. OCT is considered a potential biomarker of the early stage of AD. Identification of the relationship of the changes in retina and the optic nerve with cognitive impairment open new possibilities for the diagnosis of AD.

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The review addresses the management of primary glaucoma as a socially significant multifactorial disease. The main reasons that impede the timely diagnosis and treatment of patients with glaucoma are indicated: blurring of boundaries, conventionality of standards, and lack of individualized approach to treatment. The main risk factors for the development of glaucoma are highlighted, with special attention to hereditary predisposition and the role of “medicine of the future” in managing glaucoma. Four fundamental principles are described: personalization, prediction, prevention and participative attitude (P4 medicine). Advanced scientific understanding of the key risk factors for the development and progression of glaucoma, together with a modern personalized and personified approach will further develop precise individual strategies for the prevention and treatment of the disease.