Preventable Risk Factor of Glaucoma

Introduction: Glaucoma contributes of cases of number of irreversible blindness worldwide, with estimates reaching 112 million cases by 2040.  About 50% remain unaware in the early stages of this disease unless there is already a visual disturbance or an acute attack. Methods: This is an observational literature review. This study uses the PubMed and Google Scholar databases. The keywords searched were: Glaucoma risk factors, retinal ganglion cell damage, intraocular pressure, neuroprotection for glaucoma, metabolic disease and glaucoma. The inclusion criteria were original cohort studies, case-control studies, Randomized Controlled Trial (RCT), systematic review, and meta-analysis in the last decade in English. Non-English articles were excluded. Results: The main preventable risk factors of glaucoma are increased intraocular pressure, oxidative stress, and metabolic syndrome. for every 1 mmHg increase in intraocular pressure there will be a loss of retinal nerv fiber layer of ~0.05µm to ~0.13µm per year. Controlling intraocular pressure with medications or laser/surgery can reduce intraocular pressure by 20-70%. Oxidative stress damage retinal ganglion cell particularly in normo-tension glaucoma, regardless of intraocular pressure. Metabolic syndrome increases oxidative stress thereby exacerbating retinal ganglion cell damage. The use of citicoline and nicotinamide has been widely proven to slow down retinal ganglion cell damage in glaucoma. The relationship between blood pressure with the progression of glaucoma is still debated. Conclusion: Preventing the progression of glaucoma is important by controlling the preventable risk factors, including increased intraocular pressure, oxidative stress and metabolic syndrome. By decreasing intraocular pressure, damage to retinal ganglion cells slows down. Oxidative stress damages retinal ganglion cells regardless of intraocular pressure. Metabolic syndrome increases oxidative stress, thereby exacerbating retinal ganglion cell damage.