3rd Annual Scientific Think Tank on Optic Nerve Rescue and Restoration

Scientists from around the world engaged in research aimed at restoring sight for the blind have agreed that "a new frontier" has been reached in their ability to develop techniques to combat glaucoma, as a result of the Scientific Think Tank sponsored by The Glaucoma Foundation. For the first time, leading scientific experts on glaucoma have reached a broad consensus about how to pursue the search for a cure to the disease, which affects 50 million people.

The common understanding emerged from the Third Annual Scientific Think Tank on Optic Nerve Rescue and Restoration, held in New York City on June 7-8. The Think Tank brought together more than 40 experts from the diverse fields of neurology, ophthalmology, toxicology, pathology, surgery, biomedical engineering, and pharmacology, from Japan, Israel, Britain, Canada, and the United States.

Glaucoma, the world's leading cause of preventable blindness, occurs when cells in the optic nerve die, preventing transmission of visual images from the retina to the brain. The nerve cells can be killed by excessive fluid pressure within the eye or by other factors such as toxins within the eye. When enough cells die, loss of vision results.  (I thought it was due to the variations of pressure in the eyes!?)

Think Tank participants spent two days exploring exactly how optic nerve damage occurs, how the cells die, and how they can be protected from the various factors which can harm them. There is accumulating evidence, according to Dr. Michal Schwartz, of the Weizmann Institute of Science in Rehovot, Israel, that damage progresses even if you remove the primary cause (such as pressure) of the optic nerve disease. The search is on to find a process for rescue of the neurons that escaped the primary damage and prevention of further cell and fiber death. Scientists believe that cells which have been damaged but not killed can be rescued and continue to function, and that drugs can be developed to protect healthy nerve cells from glaucoma. The conference also explored possibilities for optic nerve fiber regeneration, that is, regrowth of optic nerve cells.

"The unique value of this Third Annual Think Tank," said Dr. Robert Ritch, Medical Director of The Glaucoma Foundation and Chief of Glaucoma at The New York Eye & Ear Infirmary, "is that it brings together top researchers in the glaucoma world from diverse disciplines for a frank exchange of questions and information." Dr. Michael Belkin of the Sheba Medical Center at Tel Aviv University in Israel agreed. "If you can prolong the survival of the optic nerve cells, you can look to the prevention of blindness," Dr. Belkin continued, describing the latest research as "encouraging."

Until recently, treatment therapies have focused on the front of the eye, where eyedrops or surgery can reduce the pressure within the eye. The Think Tank has led to the recognition that a more direct approach of treating the optic nerve itself, located at the back of the eye, is now realistic. "We have reached a new frontier, in that we can now be reasonably confident that we will be able to develop back-of-the-eye therapies for

glaucoma," said Dr. Paul Kaufman, Director of Glaucoma Services at the University of Wisconsin-Madison. "We have the tools and much of the knowledge we need. We can now talk about how and when, not if."

According to Dr. Robert Weinreb, Director, Glaucoma Center at the University of California-San Diego, "there is increasing consensus among glaucoma experts that direct treatment of optic nerve fibers can enhance traditional pressure-lowering therapy as well as offer a new alternative for patients who have not responded to current treatments."

Scientists at the meeting were in general agreement that clinical trials can be designed which will shorten the time needed to develop and obtain approval for neuroprotective drugs. They also expressed the hope that some treatments under development for other nerve diseases, such as Parkinson's, stroke, epilepsy, dementia, and Alzheimer's, may turn out to be useful for glaucoma. "We are looking for the compound that will be effective with minimal side effects," said Dr. Schwartz