The Glaucoma Research Foundation (GRF) Patient Summit highlights the latest in glaucoma treatment advances, giving patients practical information to help them live their best lives with the condition. In this sixth recording from the fourth annual Summit, Madhu S.R. Gorla, M.D.,  an ophthalmologist with Chicago Glaucoma Consultants and Assistant Professor at Rush University Medical Center, discusses current research in glaucoma.*

Researching eye disease is complex (3:13)

After decades of research, there is still no cure for glaucoma. Why? Gorla uses the analogy of a car. We know all the parts of a car and how they function as a whole. When something breaks, we usually know how to fix it. In the human eye, however:

• All the parts aren’t yet known,
• How they function together isn’t fully understood, and
• Not all parts can be seen yet.

Since its founding in 1978, the GRF has been making important strides in glaucoma research. 

• In 1997, GRF researchers discovered the TIGR gene’s role in some forms of glaucoma.
• In 1998, they established that reducing eye pressure slows glaucoma progression.
• In 2002, GRF began its Catalyst for a Cure (CFC) research program.

GRF takes a collaborative approach to find a cure, assembling teams of experts across many different disciplines besides glaucoma, to keep the focus on developing tools that have real-world relevance.

CFC 1: Neuroprotection Initiative (8:52)

Catalyst for a Cure’s first research effort was called the Neuroprotection Initiative, which investigated how to protect the optic nerve, and ran from 2002-2012. Researchers focused on two then-unanswered questions.

• How do retinal ganglion (nerve) cells die?
• Can the disease be slowed or stopped to preserve vision?

CFC 1 helped researchers understand that glaucoma is a progressive neurodegenerative disease and that it first impacts the brain and not the eye.

They realized that in glaucoma, retinal ganglion cells deteriorate gradually and lose their connection to the brain before they die—a potential therapeutic window if researchers can determine how long this process takes.

CFC 2: Biomarker Initiative (11:34)

A biomarker is a measurable sign of a biological process. In CFC 2, running from 2012-2018, researchers wanted to know whether glaucoma could be detected at an early stage, before nerve damage and vision loss occur. As a result:

• New imaging technology was created to better “see” retinal ganglion cells.
• New biomarkers have been developed, allowing for better diagnosis and treatment.
• Current clinical trials involving several biomarkers are focused on restoring vision early in the disease process.

The researchers also discovered new differences in retinal ganglion cells, with one subtype changing shape and dying earlier in the disease. This makes early treatment possible if changes can be spotted before the cells die. 

CFC 3: Vision Restoration Initiative (13:59)

Begun in 2019, CFC 3 aims to find out whether glaucoma-related vision loss can be prevented  and restored by:

• Protecting and repairing the optic nerve irrespective of eye pressure, and
• Regrowing connections between the optic nerve and brain to regain functional vision.

Researchers are looking at how to replace retinal ganglion cells and regrow the optic nerve, the eye-brain connection, to restore vision. Regrowing a nerve that’s part of the brain or central nervous system is not easy, and has challenged researchers like Gorla for decades. This is really the “holy grail” of CFC 3, says Gorla, adding that researchers are “really getting closer and closer” to that goal.

Shaffer Grant research (17:05)

The GRF’s Shaffer Grant program provides funding for “bold investigators” exploring creative avenues that have strong potential for impacting glaucoma. In 2022, Shaffer Grants were awarded to six scientists, each working on different research areas that include:

• How retinal ganglion cell axons that form the optic nerve and eye-brain connection deteriorate, and whether we can regrow these axons.
• Prevent steroid-induced glaucoma by targeting steroid-triggered enzymes that stiffen the eye’s drainage structure.
• How to detect early changes in different cells of the optic nerve.
• Stimulating nitric oxide (a vasodilator) production in the eye’s drainage pathway to lower fluid pressure.
• New ways of using optical coherence tomography (OCT) for earlier detection of optic nerve damage.
• How to detect early optic nerve damage at the junctions between individual ganglion cells before it shows up on OCT.

Glaucoma research outside of GRF (20:26)

There have been other important advances in glaucoma research besides those by the GRF. One example is research led by Bo Chen at Mount Sinai, published in the journal Cell in 2021.

Chen’s team found in animals with optic nerve damage that stimulating certain enzymes caused damaged retinal ganglion cells to regrow. Stimulating these enzymes was also shown to protect healthy optic nerve cells from damage.

Gorla encourages people to support organizations like the GRF to help continue important advances in glaucoma research.

*Glaucoma Research Foundation. (2022, August 16). Glaucoma Research Update [Video file]. Retrieved from https://www.youtube.com/watch?v=DVpidOzWd8k