Neuroprotection in Glaucoma

At Glaucoma360, Eugene de Juan Jr, MD, discussed the need, the opportunity, and approaches that target ganglion cells, axons, and vascular support.

By: Eugene de Juan Jr, MD

Glaucoma Physician February 4, 2026

Clinical Report: Neuroprotection in Glaucoma

Overview

Recent advancements in neuroprotection strategies for glaucoma focus on preserving retinal ganglion cells and axonal integrity. Innovative approaches targeting the DLK/LZK pathway and NAD+ levels show promise in preclinical models, potentially enhancing patient outcomes beyond traditional intraocular pressure management.

Background

Glaucoma remains a leading cause of irreversible blindness worldwide, primarily due to the progressive loss of retinal ganglion cells. While lowering intraocular pressure (IOP) is the only proven treatment, many patients continue to experience vision loss, highlighting the need for complementary neuroprotective strategies. Understanding the underlying mechanisms of ganglion cell and axonal damage is crucial for developing effective therapies.

Data Highlights

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Key Findings

Inhibition of the DLK/LZK pathway can protect ganglion cells even at high IOP levels.
Maintaining NAD+ levels is critical for preventing axonal degeneration, with strategies targeting SARM1 showing promise.
Nicotinamide has demonstrated neuroprotective effects in animal models and is currently being evaluated in human trials.
Vascular support targeting endothelin may improve visual field function and blood flow in glaucoma patients.
Innovative clinical trial designs could reduce the number of patients needed for trials, enhancing the efficiency of neuroprotective research.

Clinical Implications

Clinicians should remain informed about emerging neuroprotective therapies as adjuncts to IOP management. Ongoing research into the DLK/LZK pathway and NAD+ preservation strategies may offer new avenues for preserving vision in glaucoma patients. Careful monitoring and patient selection will be essential as these therapies progress through clinical trials.

Conclusion

Neuroprotection in glaucoma presents a promising frontier in preserving vision, necessitating further research and clinical validation. As our understanding of glaucoma pathophysiology evolves, so too will the strategies to combat this debilitating disease.

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Glaucoma Physician