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Gene Therapy Could Help Treat Glaucoma

Macquarie Medical School researchers have developed a technique for a gene therapy that could help treat the world's leading cause of irreversible blindness. The findings are published in the journal Molecular Therapy.

A treatment that ensures nerve cells in the eye continue to produce a vital protein that protects them from being broken down could help prevent the progression of glaucoma, researchers have found.

Glaucoma is the world's leading cause of irreversible blindness, affecting about 300,000 Australians and more than 70 million people globally. It is associated with gradual vison loss, initially in the periphery but then spreading centrally. The disease damages the optic nerve and the retinal ganglion cells, which are a type of neuron that carry visual information to the brain.

Glaucoma is often associated with increased pressure in the eye, and it can be detected during routine vision tests, by measuring the eye pressure or inspecting the optic nerve for damage with special scanners.

While any damage already sustained cannot be reversed, in many cases the progression of the disease can be slowed or stopped through treatment to lower the pressure.

However, many patients continue to worsen despite treatment, indicating there are other factors at play in addition to pressure.

Professor of Ophthalmology Stuart Graham from Macquarie Medical School is leading a team that is investigating the role of the protein neuroserpin in the disease.

Vision Neurobiologist Associate Professor Vivek Gupta says they have found that neuroserpin, which is produced in the connectors between nerve cells, is vital in protecting retinal ganglion cells.

"Other researchers have linked changes in neuroserpin to stroke and neurodegenerative disorders like Alzheimer's and Parkinson's diseases, but our work is the first to relate it to glaucoma," says Professor Gupta.

"Cells naturally break down and are recycled in the body, but when neuroserpin is absent, this process speeds up in the retina.

"Essentially, the body begins to eat away at the retinal ganglion cells and the optic nerve."

Oxidation is a common cause of molecular breakdown in nature. Iron rusting and a cut apple turning brown are both familiar examples.

The team has discovered that when neuroserpin oxidizes, it loses its protective ability, allowing accelerated cell breakdown.

They have also shown that when mice produce more neuroserpin, it has a protective effect, promoting the survival of the retinal ganglion cells and minimizing glaucoma damage.

Vision Scientist Dr. Nitin Chitranshi says in the latest work, detailed in an article in the latest edition of Molecular Therapy, the team has successfully manipulated a gene in mice to produce a version of neuroserpin that is resistant to oxidation.

"When we introduce this gene directly to the eye, it increases the production of neuroserpin in the retina," says Dr. Chitranshi.

"Currently, that involves injecting it into the eye, which is obviously quite confronting, but we are working on a way to introduce the gene using a synthetic virus that can be targeted to specific cells in the retina.

"The artificial virus would not have any effect on the body, but would act as a carrier for the therapy, allowing our specially developed nanoparticles to get inside the cells and tell them to produce our modified neuroserpin.

"We are also working on a way for the protein to give its instructions to produce neuroserpin only to the retinal ganglion cells and not to other neurons, so it can be perfectly targeted."

The team is now preparing for further testing of the enhanced gene and will commence new trials shortly.

Professor Graham says glaucoma is a complex disorder involving a number of mechanisms, not all of which are well understood. "For this reason, our gene therapy is unlikely to be a silver bullet for all glaucoma, but we have great hopes that it will become a valuable part of treatment for use in conjunction with other therapies, making the nerve cells more resistant to damage," he says.

More information: Nitin Chitranshi et al, Neuroserpin gene therapy inhibits retinal ganglion cell apoptosis and promotes functional preservation in glaucoma, Molecular Therapy (2023). DOI: 10.1016/j.Ymthe.2023.03.008

Citation: Gene therapy could help treat glaucoma (2023, June 27) retrieved 28 June 2023 from https://medicalxpress.Com/news/2023-06-gene-therapy-glaucoma.Html

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Glaucoma Classifications

There are several specific types of glaucoma. Some of these are:

Primary open angle glaucoma

In this type of glaucoma the optic nerve damage resulting from increased pressure in the eye is caused by trabecular blockage which is where the aqueous humor in the eye drains out. All patients with open angle glaucoma do not have eye pressure that is elevated beyond normal, but decreasing the eye pressure further has been shown to stop progression of loss of vision. Vision loss is a gradual process and peripheral vision is affected first, however, eventually the entire vision will be lost if not treated. Diagnosis is made by looking at changes in the optic nerve cup. Prostoglandin agonists like lataniprost and parasympathetic analogs like pilocarpine help by opening uveoscleral passageways for drainage. Beta blockers such as timolol and Alpha 2 agonists (brimonidine, apraclonidine), are also beneficial by decreasing aqueous formation. Similarly Carbonic anhydrase inhibitors like dorzolamide and acetazolamide help in decreasing bicarbonate formation from ciliary processes in the eye, thus decreasing formation of Aqueous humor.

Angle-closure glaucoma

This type of glaucoma occurs due to narrowing of the angle between the iris and trabecular meshwork, which in turn obstructs outflow of the aqueous humor from the eye. This narrowing damages the function of the meshwork until it fails to keep pace with aqueous production, and the pressure rises. In some cases, pressure may rapidly build up in the eye causing pain and redness. This is called acute angle closure glaucoma. In this situation the vision may become blurred, and halos may be seen around bright lights along with severe headache and vomiting. After initial treatment with medications definitive treatment is laser iridotomy. This may be performed using either Nd:YAG or argon lasers, or in some cases by conventional incisional surgery.

Normal tension glaucoma (low tension glaucoma)

Glaucoma occurs in absence of a raised mean IOP on diurnal testing. There may be presence of optic nerve damage and an open angle between the iris and the cornea. Elderly and females are usually prone to this type of glaucoma. May be associated with the Raynaud's phenomenon, migraines, paraproteinaemia. Treatment is by reducing intraocular pressure as for open angle glaucoma. The aim is to reduce IOP by 30%. It is also recommended that systemic blood pressure be monitored over 24 hours, as normal tension glaucoma may be associated with nightly low blood pressure. There is often a delay in diagnosis, resulting in more advanced visual field defects. Patients with defects in one eye have a 40% chance of developing defects in the fellow eye over 5 years.

Secondary glaucomas

These are caused as a result of blockage of the aqueous outflow system due to other eye diseases. Types include:

  • Pseudoexfoliative glaucoma – Secondary to pseudoexfoliation syndrome. A dusty grey deposit of extracellular amyloid-like material is deposited on the anterior lens capsule, the zonules, the ciliary body and in the trabecular network. This clogs up the drainage of the fluid. It is common among elderly and females. Treatment is with medications and laser surgery.
  • Pigmentary glaucoma – Here a pigment deposits from the posterior surface of the iris to block the drainage system. Common among young (20-40 year-old), male, Caucasians with high myopia. Treatment is with medications and laser surgery.
  • Neovascular glaucoma – This occurs due to iris neovascularisation (rubeiosis iridis). This can occur after ischaemic retinal vein occlusion, advanced diabetic eye disease, central retinal artery occlusion, intraocular tumours, long-standing retinal detachment and where there has been chronic intraocular inflammation. Treatment is with panretinal photocoagulation and possibly retinal surgery.
  • Primary congenital glaucoma

    This includes types like infantile glaucoma and glaucoma associated with hereditary of familial diseases.

    Other types of glaucoma
  • Inflammatory glaucoma – There may be fluctuating IOPs and a ciliary body closure. It is the most common cause of blindness in children and young adults with chronic anterior uveitis. Treatment is mainly with medications but severe cases may require surgery too.
  • Lens-related glaucoma – The lens may cause phacolytic glaucoma due to a hypermature cataract leading to shedding of proteins which clog up the drainage system or phacomorphic glaucoma where the lens swells and bulges forward, compressing the trabecular meshwork. Both need prompt cataract surgery.
  • Traumatic glaucoma – Here glaucoma occurs secondary to eye injury. The red blood cells can block the trabecular meshwork. It is seen in 6-9% of patients over a 10-year period.
  • Iridocorneal endothelial (ICE) syndrome – Affects one eye in young- to middle-aged women. There are iris abnormalities which are associated with glaucoma in 50% of cases. Treatment is medical and surgical.
  • Glaucoma in ciliochoroidal detachment – This is seen after a detachment of the ciliary body or choroid that leads to displacement of the lens-iris complex resulting in shallow iridocorneal angles which may close off.
  • Glaucoma in epithelial ingrowth – This is seen after anterior segment trauma or surgery. Conjunctival and corneal epithelial cells migrate from the external surface of the eye and may block off the aqueous outflow. Treatment involves surgery and cryotherapy.
  • Sturge-Weber syndrome is associated with early presentation of patients with glaucoma (60% within the first 2 years of life).
  • Neurofibromatosis-1 patients may also (uncommonly) present with unilateral, congenital glaucoma.
  • Iridocorneal dysgenesis is seen in conditions like Axenfeld-Rieger syndrome, Peters' anomaly, aniridia and is associated with glaucoma.
  • Glaucoma in cavernous-sinus fistula – This is caused due to raised episcleral venous pressure that impairs the aqueous outflow. Medical treatment is required until the shunt resolves or is treated.
  • Glaucoma in intra-ocular or eye tumours – The glaucoma depends on the site of the tumour but it occurs in about 5% of affected eyes.
  • Glaucoma in iridoschisis – There is iris atrophy which is associated with glaucoma in 90% of cases. Laser treatment followed by drug treatment is necessary.
  • Further Reading

    Ophthalmology Lasers Market Size, Share, Demand, Future Growth, Challenges And Competitive Outlook Report

    United States Ophthalmology Lasers Market are specialized medical devices that emit focused beams of light to treat various eye conditions. These lasers are commonly used in ophthalmology to perform various procedures, such as treating vision disorders, correcting refractive errors, and managing various eye diseases. The devices gained increased importance and adoption due …

    New York United States - June 21, 2023 —

    Ophthalmology Lasers Market are specialized medical devices that emit focused beams of light to treat various eye conditions. These lasers are commonly used in ophthalmology to perform various procedures, such as treating vision disorders, correcting refractive errors, and managing various eye diseases. The devices gained increased importance and adoption due to the high prevalence of several ophthalmic diseases, such as glaucoma, cataract, and other vision-related issues.

    The global ophthalmology lasers market is expected to gain market growth in the forecast period of 2023 to 2030. Data Bridge Market Research analyses that the market is growing with a CAGR of 6.2% in the forecast period of 2023 to 2030 and is expected to reach USD 3,478.03 million by 2030 from USD 2,152.97 million in 2022.S

    Get a PDF Sample of the Ophthalmology Lasers Market @  https://www.Databridgemarketresearch.Com/request-a-sample/?Dbmr=global-ophthalmology-lasers-market&shri

    Market Overview:

    This ophthalmology lasers market report provides details of new recent developments, trade regulations, import-export analysis, production analysis, value chain optimization, market share, the impact of domestic and localized market players, analyses opportunities in terms of emerging revenue pockets, changes in market regulations, strategic market growth analysis, market size, category market growths, application niches and dominance, product approvals, product launches, geographic expansions, technological innovations in the market. To gain more info on the ophthalmology lasers market, contact Data Bridge Market Research for an Analyst Brief. Our team will help you take an informed market decision to achieve market growth.

    Ophthalmology lasers are specialized medical devices that emit focused beams of light to treat various eye conditions. These lasers are commonly used in ophthalmology to perform various procedures, such as treating vision disorders, correcting refractive errors, and managing various eye diseases. The devices gained increased importance and adoption due to the high prevalence of several ophthalmic diseases, such as glaucoma, cataract, and other vision-related issues.

    Drivers

    Increasing incidences of chronic and communicable eye diseases

    The field of ophthalmology has seen a rise in the incidence of both chronic and communicable eye diseases in recent years. Some of the major factors contributing to this trend include a growing global population, an aging population, increased urbanization, changing lifestyles, and increased exposure to environmental pollutants. One of the most common chronic eye diseases is Age-Related Macular Degeneration (AMD). AMD is a leading cause of blindness in people over the age of 60 and is caused by damage to the macula, a small part of the retina responsible for central vision. The prevalence of AMD is expected to increase with an aging global population. Another chronic eye disease that is becoming more prevalent is glaucoma. Glaucoma is a group of eye diseases that cause damage to the optic nerve and can lead to blindness. It is often asymptomatic until it reaches an advanced stage, making regular eye exams crucial for early detection and treatment.

    In March 2023, according to an article by Indian Express, globally, glaucoma is the second leading cause of blindness after cataracts. It is estimated to cause blindness in 4.5 million people worldwide. Despite this, glaucoma is largely undiagnosed, with more than 90 percent of untreated cases. Thus, increasing incidences of chronic and communicable eye diseases are expected to drive the market's growth.

    Increasing adoption of outpatient procedures

    The field of ophthalmology has seen significant advancements in recent years with the advent of laser technology. With the increasing adoption of outpatient procedures, the global ophthalmology lasers market presents a significant opportunity for growth. Outpatient procedures are medical procedures that do not require an overnight stay in a hospital. These procedures can be performed in a medical office, ambulatory surgery center, or outpatient clinic. Thus, the increasing adoption of outpatient procedures is expected to drive the market's growth.

    Market Development

  • In February 2023, NIDEK CO., LTD., a global leader in the design, manufacture, and distribution of ophthalmic, optometric, and lens edging equipment, announced the launch of the Cube α Ophthalmic Surgical System, which incorporates new ultrasound technology that delivers more powerful and effective phacoemulsification.
  • In January 2023, iVis Technologies announced that it has been undertaking the expansion works of its corporate headquarters since June 2022.
  • In July 2022, SCHWIND eye-tech solutions is continuing its role as an innovation driver in refractive corneal surgery and have its sights set on a groundbreaking procedure for correcting ametropic.
  • In February 2022, Calmar introduced a power and pulse-width stabilization system for its Carmel X-series of femtosecond fiber lasers. The Opta Power system is designed for users who need to measure extremely small signal levels and require hours for data acquisition.
  • In September 2022, LENSAR, Inc. (Nasdaq: LNSR) ("LENSAR" or "the Company"), a global medical technology company focused on advanced femtosecond laser surgical solutions for the treatment of cataracts, announced the application for certification of the ALLY Adaptive Cataract Treatment System ("ALLY" or the "ALLY System") in the European Union.
  • Browse a Detailed Summary of Ophthalmology Lasers Market Research Report @ https://www.Databridgemarketresearch.Com/reports/global-ophthalmology-lasers-market?Shri

    Major Players

    Data Bridge Market Research recognizes the following companies as the market players in the global ophthalmology lasers market are NIDEK CO., LTD. (Japan) iVIS Technologies (Italy), SCHWIND eye-tech-solutions (Germany), ARC Laser GmbH (Germany), Calmar Laser (US), LENSAR, INC. (US), OD-OS (Germany), Quantel Medical (Subsidiary of Lumibird Medical) (France), Aurolab (India), Alcon (Switzerland), Ziemer Ophthalmic Systems AG (Switzerland), LIGHTMED (U.S.), Johnson & Johnson Inc. (U.S.), Bausch & Lomb Incorporated (Canada), MEDA Co., Ltd. (China), Topcon(Japan), Lumenis Be Ltd. (Israel), IRIDEX Corporation (U.S.), and Zeiss (Germany) among others.

    Global Ophthalmology Lasers Market Scope

    Product

  • Femtosecond Lasers
  • Excimer Lasers
  • Nd: YAG Lasers
  • Diode Lasers
  • Others
  • Type

  • Photodisruption Lasers
  • Selective Laser Trabeculoplasty (SLT)
  • Photocoagulation Lasers
  • Application

    Gases

  • Noble gas
  • Halogen gas
  • Buffer gas
  • Others
  • End User

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    An absolute way to forecast what future holds is to comprehend the trend today!

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