Should we treat the brain in glaucoma?

The loss of retinal ganglion cells in glaucoma may lead to blindness, and current therapies are directed at reducing pressure within the eye. Most of the retinal ganglion cell axon lies outside the eye, and evidence from experimental primate and human glaucoma suggests that axon injury extends from the optic nerve to visual pathways in the brain. Neurodegenerative changes in the central visual system may contribute to the pathology of glaucomatous progression. Thus, intraocular pressure-lowering strategies combined with neuroprotective therapies to protect visual neurons in the retina and brain may help to preserve vision in patients with glaucoma.