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Understanding dead vs dormant optic nerve cells

Submitted by dave on Sun, 11/30/2014 - 1:31pm

A FitEyes member sent some comments and questions today regarding what happens to dead or non-functional optic nerve cells. I have replied inline below so you can read his comments and my responses.

I am impressed with the enormous amount of knowledge some of you have about glaucoma.
Thanks for saying that. I too am impressed by the wealth of knowledge in our community!
I was diagnosed with glaucoma two years ago and as all of you am looking for ways to get better.
I believe we can improve. It is my belief that the optic nerve can regenerate.
Q. Can anyone tell me what happens to dead optic nerve cells (ONC)? Does the body flush them away or do they remain in their shriveled state?
In glaucoma apoptosis (as opposed to necrosis) is the main pathway to retinal ganglion cell death. Apoptosis is a natural type of self-induced destruction. (It is called programmed cell death, although I personally think that term is misleading.) It is contrasted with externally induced tramatic destruction (necrosis).

However, apoptosis does occur in response to the cell's environment (as noted below). So if you want to call it programmed cell death, note that information from the cell's environment is the input into this program. Something triggers the program to run. It is a response to the milieu and I see it in a holistic way (which is not always how it is explained in the textbooks).

In the eye there is rapid phagocytosis of the apoptotic debris. This means that immune cells (e.g. glial cells) engulf the apoptotic debris. This is a type of clean up process. It helps prevent auto-immune responses and other unwanted responses. However, some experts feel that, in glaucoma, the phagocytosis often extends to nearby healthy retinal ganglion cells, thus spreading the damage beyond what the ideal natural process would represent. This is all my own understanding. I trust that any experts reading the above will offer any needed corrections.

From Neuroprotection in Glaucoma: Mechanisms believed to cause stress to retinal ganglion cells and to initiate the apoptotic cascade include:
  • biomechanical stress [52, 53],
  • excitotoxicity [54-57],
  • tissue hypoxia (insufficient oxygen) [58, 59],
  • altered nutritional blood supply [60, 61],
  • mitochondrial dysfunction [62-65],
  • Müller glial cell activation (glial hyperactivation) [66],
  • protein misfolding [67-69],
  • oxidative stress [70, 71],
  • dysfunctional autoimmunity [72],
  • neurotrophin deprivation [73, 74],
  • inflammation [75, 76]
  • (see references below)
Q. There also must be millions of  stunted, dormant," hibernating" ONCs, for otherwise how can microcurrent bring them partly back to life?
I think the above facts give a slightly different perspective. However, there do appear to be some number of retinal ganglion cells that can regain function.
Q. This procedure is available in Germany but is expensive and seems to last less than a year.
It's too new to say much about how long it lasts or what its true potential is. It is also too early to say if it is the ideal way to revive the non-functional cells. My own belief is that meditation is a superior (and safer) way to achieve this result.
Q. I would like to believe in resurrection for the only alternative is stem cell therapy which is probably a dozen years away.
No, there are many other possible alternatives. I don't think it is healthy for us patients to close our minds to all the alternatives. After all, given that stem cells are a natural process, why does it require medical intervention for us to take advantage of this process? I think natural methods such as meditation can trigger the natural process of optic nerve regeneration, although science may not yet know that...
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