What is the role of apoptosis in the etiology of primary open-angle glaucoma (POAG)?

Updated: Mar 16, 2020
  • Author: Kristin Schmid Biggerstaff, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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Answer

The disease affects the individual axons of the optic nerve, which may die by apoptosis, also known as programmed cell death, as follows:

  • There has been some laboratory data that shows glutamate may play a role in glaucoma-related apoptosis, via neurotransmitter excitatory toxicity. However, so far, a human subject trial of the glutamate inhibitor (also referred to as an N-methyl D-aspartate [NMDA] inhibitor), memantine, has been unsuccessful in meeting its endpoints. To date, it has not been specifically approved by the US Food and Drug Administration (FDA) for the treatment of glaucomatous optic neuropathy. It is available in the United States and is approved for the treatment of other neurodegenerative diseases, such as certain types of dementia.

  • As a whole, the subjects in the memantine trial did not show a significant difference in their rates of progression whether on memantine or placebo. However, on further analysis of the different study population subgroups, those subjects with severe glaucomatous vision loss did possibly show a benefit on memantine. Future studies are needed to confirm, characterize, and quantify this potential benefit.


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