Diabetes Mellitus and Retinal Vein Occlusion as Risk Factors for Open Angle Glaucoma and Neuroprotective Therapies for Retinal Ganglion Cell Neuropathy

Abstract

of glaucoma (NTG), and the prevalence of NTG is 3.6% in patients >40-years-of-age in Japan [10]. The average intraocular pressure (IOP) in patients with POAG is 15.4 ± 2.8 mmHg, which is significantly higher than that of normal subjects (14.5 ± 2.5 mmHg) [1][2][3][4][5][6][7][8][9][10] even though the average difference in the IOP is only 0.9 mmHg. Thus, a reduction of the IOP the standard therapy for glaucoma may not be sufficient for the complete management of the patients with glaucoma in Japan. Other therapeutic modalities, such as neuroprotection, should be considered for a complete therapeutic regimen for glaucoma patients.RGC death and axonal degeneration are most likely involved in the progression of DR, RVO, and glaucoma. Many neuroprotective therapies that prevent RGC death and axonal degeneration have been and are being investigated, and some of these neuroprotective factors may be used clinically in the near future. To establish neuroprotective therapies for DR, RVO and glaucoma, a determination of the exact mechanism that leads to a progression of RGC neuropathy to death and axonal degeneration is required [11]. However, the pathogenesis of the onset and progression of RGC neuropathy has still not been definitively determined. Identification of the risk factors for the onset and the progression of disease would help in determining the Abstract Glaucoma, diabetic retinopathy (DR), and retinal vein occlusion (RVO) are major diseases that can lead to blindness and affect mainly the elderly population worldwide. The results of recent investigations have demonstrated that the death of retinal ganglion cells (RGCs) and their axons is the common pathological change in these three disease processes. The exact mechanism that is responsible for the onset and progression of RGC death and axonal degeneration in patients with glaucoma, DR and RVO has not been definitively determined. Thus, identifying the risk factors for the onset and the progression of RGC neuropathy can help in deciding not only the specific treatments but also whether the treatments should be initiated, withheld, or augmented in individuals with glaucoma, DR, and RVO. This review describes the major risk factors for the onset of glaucoma, and the factors associated with the progression of glaucoma that have been obtained from large population-based prevalence and incidence studies. In addition, the potential risk factors for glaucoma, diabetes mellitus, and RVO are discussed in terms of the results obtained by both clinical and laboratory studies. This review introduces potential neuroprotective therapies for damaged RGC in eyes with RGC neuropathy, and the factors that should be considered for a complete therapy for the RGC neuropathy involved in glaucoma, DR and RVO. Neuroprotective therapies combined with a reduction of the IOP should be considered for the complete management of RGC neuropathy involved in glaucoma,

Clinical Risk Factors Underlying the Occurrence of Retinal Vein Occlusion

“…CRVO was associated with increased intraocular pressure (IOP), primary open-angle glaucoma and ocular hypertension [25] . There is a strong correlation between glaucoma and CRVO because of the association of optic disk cupping with distortion of the retinal vessels at the disk, predisposing the vein to occlusion [25] .…”

“…There is a strong correlation between glaucoma and CRVO because of the association of optic disk cupping with distortion of the retinal vessels at the disk, predisposing the vein to occlusion [25] . The…”

“…The patients with thinner RNFL in the contralateral eye had the same IOP as the controls which suggested the possibility that OAG and RVO shared a common vascular abnormality [26] . Papilledema due to raised pressure in the optic nerve sheath may cause further compression to central retinal vein and contribute to CRVO [25] . Hyperopia and anatomic structure of the eye is also an important risk factor for CRVO.…”

The Effect of Citicoline on Electroretinography Abnormalities in Patients with Non-proliferative Diabetic Retinopathy

“…4 Ganglion cells, in the inner layer of the retina, are the most involved cells in the pathological process in diabetes. 5 Citidine diphosphocoline (CDP-choline or citicoline) CDP-choline is an essential intermediate in the synthesis of structural phospholipids of cell membranes, phosphatidylcholine. 6 After neural death process, exogen citicoline will participate in the phospholipid synthesis at the neuronal membrane cells.…”