The bottom line: the authors propose that glaucomatous patients could be advised to change several aspects of their lifestyle, such as increasing social interactions, physical exercise, and cognitive challenges. This is a forward-looking recommendation based on preclinical research.
From the paper:
Taken together, our results support visual stimulation as a plausible potent stimulus achieving retinal protection in adult rats, possibly through a mechanism related to BDNF/TrkB. In line with our results, high-contrast visual stimulation induces axonal regeneration after ON crush due to increased RGCs activity (Lim et al., 2016). Although a similar visual stimulation protocol was used in the report by Lim and collaborators, the authors show an enhanced axonal regeneration with biased visual stimulation to the lesioned nerve through the occlusion of the intact eye, combined with the induction of the mammalian target of rapamycin pathway. Differences between the effect of visual stimulation to the non-lesioned or lesioned pathway to induce retinal or ON neuroprotection could be explained by the lesion site and the pathogenic mechanisms involved in each experimental model.
Since acute retinal ischemic damage shares some of the pathogenic mechanisms involved in chronic glaucoma, it is tempting to speculate that visual stimulation could also protect the retina and ON against glaucomatous injury, a hypothesis that is currently under investigation.
There is evidence in humans showing that experimental paradigms analogous to a the experimental "enriched environment" (a living environment that encourages exploratory, sensory, and cognitive activity, social interaction, and voluntary physical exercise), such as playing video games or being trained in perceptual learning tasks, can be quite successful in eliciting amblyopia recovery in adult subjects (Foss, 2017).
Although amblyopia involves an alteration that mainly impacts on the visual cortex, whereas glaucoma primarily affects retinal and ON cells, it seems that visual stimulation could be a rehabilitative therapy for retinal disorders in adulthood that eventually may translate to the human condition, averting glaucoma-induced dreaded sequelae that result in permanent visual disability.
One of the many complications of glaucoma is its chronicity, which implies that treatments (of any kind) should be considered in the long-term. For mimicking enriched environments (as described for rodents), glaucomatous patients could be advised to change several aspects of their lifestyle, such as increasing social interactions, physical exercise, and cognitive challenges.
In the case of visual overstimulation, a very frequent application (e.g., playing video games once or twice a day) would be useful.
In this way, preservation of the visual functions in glaucomatous patients through an intensified use of the sensory and motor systems, and/or social interactions could be a novel, harmless, and non-invasive strategy to promote visual recovery.
- Neural Regen Res
- 2022 Jul;17(7):1431-1439.
- A novel viewpoint in glaucoma therapeutics: enriched environment - PubMed
- María F González Fleitas et al
- PMID: 34916414
- PMCID: [PMC8771091]
- DOI: [10.4103/1673-5374.330594]
- Free PMC article