11 November 2025
Professor Augusto Azuara-Blanco discussed a range of emerging treatment approaches for glaucoma during his presentation at the Hospital and Specialty Optometrists Conference (London, 8–9 November).
The Queen’s University Belfast academic highlighted that within glaucoma care at present, there are some patients whose disease will progress despite treatment and low intraocular pressure (IOP).
“There is an unmet need,” Azuara-Blanco said.
Azuara-Blanco highlighted that clinical trials have illustrated the anti-oxidant and anti-inflammatory properties of cannabinoids, which have also been shown to lower IOP.
In 2026, Azuara-Blanco and colleagues will recruit 10 participants to a trial exploring the effects of an oral synthetic cannabinoid on glaucoma.
“It is currently used within trials for people with cancer and anorexia – so it is safe,” he said.
Azuara-Blanco also discussed the potentially therapeutic effects of nicotinamide – a derivative of vitamin B3 – in glaucoma.
He highlighted that nicotinamide crosses the blood-retina barrier, enhancing mitochondrial resistance and reducing oxidative stress.
Azuara-Blanco added that nicotinamide has several advantages as a therapeutic approach – it is safe, inexpensive and accessible.
He shared his view that nicotinamide is a safe adjunct to conventional IOP-lowering therapy.
“We are expecting a decision on this within five years – it may seem like a long time, but believe me, five years is nothing. The typical cycle of a glaucoma trial is 10 years, so we are halfway through. It is very exciting,” Azuara-Blanco said.
Azuara-Blanco noted that metformin is being investigated as a potential alternative therapy for glaucoma, after clinicians noticed a reduced incidence of glaucoma among diabetics on this medication.
He added that pre-clinical studies involving GLP-1 agonists (such as semaglutide) have shown that the drug may be neuroprotective and prevent the progression of glaucoma.
Turning to the role of stress within glaucoma, Azuara-Blanco highlighted that anxiety and stress can affect up to 40% of glaucoma patients.
He noted that while better evidence is needed to support a link between glaucoma and stress, clinicians can encourage patients to take part in activities that promote relaxation as an adjunct to conventional medical treatment.
Azuara-Blanco added that clinicians may advise patients with moderate or severe glaucoma to avoid head-down yoga poses.
Addressing the effect of exercise on IOP, Azuara-Blanco highlighted that moderate aerobic exercise lowers IOP by 1–5mmHg for between 30 minutes to an hour.
He noted that regular moderate activity is linked to a lower incidence of glaucoma, while higher fitness levels are linked to slower glaucoma progression.
Azuara-Blanco highlighted that patients who take part in intense resistance training – which can raise IOP temporarily – may be advised to modify their technique.
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