CONTROVERSIES IN THE VASCULAR MECHANISMS OF GOND
Research on a micro- and macro-level is being performed in
institutions across the globe, all targeting glaucoma in some way. But despite
quantum leaps in our understanding of this disease, management of glaucoma
still flounders around a perfect way to just control intra-ocular pressure. That
is the ONLY controllable risk factor identified after millions of dollars spent
on research and development.
At this moment in time, the 2 pertinent QUESTIONS which
every person probably wants to ask are:
1.
Why does glaucoma occur? (MECHANISMS)
2.
Where can we find a treatment to stop visual
deterioration or better still, to recover visual loss? (NEUROPROTECTION and
NEUROREGENERATION)
Unfortunately, we are still unable to answer even these 2
questions. My interest in glaucoma revolves around these 2 questions. I want to
know why glaucoma occurs and is there any way to stop its damaging effects?
Saying that multifactorial mechanisms are at work is just an easy way out to escape
our responsibility in delving deeper into the etiology and mechanisms of
glaucoma causation. A parent who loses a young son or daughter in a car
accident cannot be soothed by an explanation that the car was driven at 200mph,
it was raining, the driver was distracted by a phone call and the road was poorly
lit. The parent wants to know what could have been done to avoid this accident and
what steps are being taken to prevent such accidents in the future. Glaucoma is
a similar situation for patients who suffer from this cruel disease. What answer
do we have for patients who come with advanced disease, hoping for their
problems to be solved by a simple drug or operation?
A few years back I searched into the biochemical mechanisms
of glaucoma. It was such a painful conclusion to know that there are possibly hundreds
of mediators of glaucomatous optic nerve degeneration (GOND) in our bodies and the
environment. How will we ever tackle all of them?
Now, I tried to look into the vascular mechanisms. The result
is equally distressing. I feel a bitter anguish that we still do not have
enough solid evidence to introduce this aspect of the disease in our management
protocols. Calcium channel blockers are being explored in certain groups of
patients but the results are still inconclusive.
I hope this article of mine will stimulate researchers into
working on the vascular mechanisms of GOND and one day down the line we might
be able to really control glaucoma.
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