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A groundbreaking study published in Nature Medicine sheds light on how patients with glaucoma may respond to treatment, potentially revolutionizing the management of this sight-threatening condition. With over 700,000 individuals affected in the UK alone, glaucoma remains the leading cause of irreversible blindness worldwide. The disease primarily results from the progressive death of retinal ganglion cells, critical components of the eye’s visual pathway.
Current treatments focus on lowering intraocular pressure (IOP), a significant risk factor for glaucoma, yet many patients continue to experience vision loss despite adhering to prescribed therapies. This discrepancy has prompted researchers to explore alternative biomarkers that could predict treatment outcomes.
Led by Professor David (Ted) Garway-Heath from the UCL Institute of Ophthalmology and Moorfields Eye Hospital, the study investigated mitochondrial function in white blood cells as a potential predictor of glaucoma progression. Mitochondria are the cellular “batteries” that generate energy, and their efficient functioning is crucial for high-energy-demand cells like those in the eye.
The research involved 139 glaucoma patients already receiving IOP-lowering treatments and a control group of 50 healthy individuals. Key measurements included oxygen usage in peripheral blood mononuclear cells and levels of nicotinamide adenine dinucleotide (NAD), a molecule essential for energy production and derived from vitamin B3.
Findings revealed that glaucoma patients exhibited distinct oxygen utilization patterns in their blood cells. Notably, individuals whose blood cells demonstrated reduced oxygen consumption tended to experience more rapid vision loss, accounting for approximately 13% of the variance in visual deterioration rates. Furthermore, lower NAD levels were found in the blood cells of glaucoma patients, correlating with diminished oxygen usage.
Professor Garway-Heath emphasized the clinical implications of these findings: “By introducing white blood cell mitochondrial function and NAD levels as routine tests, clinicians could identify patients at higher risk of ongoing vision loss. This would allow for more intensive monitoring and tailored treatment strategies.”
He also highlighted the potential for innovative therapeutic approaches. If further research establishes a causal link between low mitochondrial function or NAD levels and glaucoma, it could pave the way for new treatment modalities. Notably, UCL and Moorfields Eye Hospital are spearheading a major clinical trial to investigate whether high-dose vitamin B3 can enhance mitochondrial function and mitigate vision loss in glaucoma patients.
“This could open new avenues for glaucoma treatment beyond the traditional focus on lowering eye pressure,” Garway-Heath concluded.
As research progresses, the hope is to empower clinicians with tools that can better predict glaucoma outcomes and ultimately improve patient care.
For more information: Petriti, B. et al. “Peripheral blood mononuclear cell respiratory function is associated with progressive glaucomatous vision loss,” Nature Medicine (2024). DOI: 10.1038/s41591-024-03068-6.
