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Glaucoma neuroprotection moves into clinical trials

Implant shows significant increase in nerve fibre layer thickness

Howard Larkin

Posted: Friday, October 18, 2019


Jeffrey L Goldberg MD, PhD

Innovative study designs and integrating therapeutic testing with biomarkers have advanced several neuroprotective and neuroenhancement compounds to clinical trials, which could advance glaucoma therapy beyond prevention through IOP control, Jeffrey L Goldberg MD, PhD, told AAO 2019 Glaucoma Subspecialty Day in San Francisco, USA.

Interim analysis of a phase II trial of Ciliary Neurotrophic Factor implant shows a statistically significant increase in nerve fibre layer thickness and a trend toward better visual fields with no treatment-limiting adverse effects after one year, said Dr Goldberg, who is professor and chair of ophthalmology at Stanford University, Palo Alto, California, USA.

An eight-week phase I/II randomised clinical trial of nerve growth factor eye drops also has been conducted, as has a successful phase Ib randomised study of an anti-C1q intravitreal injection for glaucoma. A phase Ib randomised study of virtual reality visual stimulation approach using VR goggles to stimulate RGC cells or balancing inter-eye competition is also in the works.

These studies can produce results in a shorter time than previous neuroprotection studies by focusing on rapidly progressing patients and clustering visual field tests to hedge against variability in 12- to 18-month tests, and studying sick, but not dead, RGCs in shorter neuroenhancement studies, Dr Goldberg said. Both types incorporate new exploratory biomarkers.