Neuroprotection of medical IOP-lowering therapy

Cell Tissue Res. 2013 Aug;353(2):245-51. doi: 10.1007/s00441-013-1671-1. Epub 2013 Jul 9.


Intraocular pressure (IOP)-lowering therapy has been shown to arrest or retard the progression of optic neuropathy typical for glaucoma and can, thus, be described as neuroprotective. At present, six classes of medical therapy are employed, namely parasympathomimetics, alpha/beta-sympathomimetics, β-blockers, carbonic anhydrase inhibitors, α2-adrenergic receptor agonists and prostaglandin analogues. For several of these substances, some experimental evidence exists of a possible neuroprotective mechanism, beyond their IOP-lowering activity. β-Blockers are involved in the up-regulation of brain-derived neurotrophic factor (BDNF) and can decrease glutamate-mediated NMDA receptor activation. Not only systemic but also topical carbonic anhydrase inhibitors are able to increase retinal blood flow. α2-Adrenergic receptor agonists can up-regulate the formation of BDNF and anti-apoptotic factors. Prostaglandin analogues increase blood flow to the eye, possibly including the retina. To date, evidence for a neuroprotective effect independent of IOP regulation in human glaucoma is scarce and has only been shown to be likely for the α2-adrenergic receptor agonist, brimonidine.

Publication types

  • Review

MeSH terms

  • Animals
  • Antihypertensive Agents / pharmacology*
  • Antihypertensive Agents / therapeutic use
  • Cytoprotection / drug effects*
  • Glaucoma / drug therapy
  • Glaucoma / physiopathology
  • Humans
  • Intraocular Pressure / drug effects*
  • Neurons / drug effects
  • Neurons / pathology*
  • Neuroprotective Agents / pharmacology*
  • Neuroprotective Agents / therapeutic use


  • Antihypertensive Agents
  • Neuroprotective Agents