Nutraceuticals and neuroprotection for glaucoma—introducing the NP-10 System

Glaucoma, a leading global cause of irreversible blindness, often progresses despite adequate intraocular pressure (IOP) control, highlighting a crucial unmet need for neuroprotective strategies that directly promote retinal ganglion cell survival. In addition, the glaucoma standard of care is often reactive, initiating only on measurable structural or functional loss and lacking in structured, proactive approach to neuroprotection. This review introduces the NP-10 System, a novel conceptual framework designed to systematically address 10 diverse and interrelated neuroprotective mechanisms implicated in glaucomatous neurodegeneration. Broadly, these can be categorized as pressure-related factors (direct IOP and psychological stress), vascular factors (encompassing vascular dysregulation and homocysteine-related endothelial dysfunction), cellular dysfunctions (mitochondrial dysfunction, glycolysis impairment, oxidative stress, and chronic inflammation), and functional deficits (macular pigment deficiency and impaired axonal function). Specific nutraceutical interventions, including saffron, French maritime pine, bilberry, palmitoylethanolamide, nicotinamide, methylfolate, methylcobalamin, macular carotenoids, Ginkgo biloba, pyruvate, and citicoline, may target multiple mechanisms to reduce IOP, modulate stress, improve ocular perfusion, enhance cellular bioenergetics, provide antioxidant and anti-inflammatory benefits, augment macular pigment, and improve visual function in glaucoma. With promising emerging evidence for neuroprotection, the NP-10 System provides a scaffold for future large, randomized trials to establish clinical efficacy, optimize formulations, and clarify safety profiles of these nutraceuticals, paving the way for integrating targeted nutritional support into proactive glaucoma care.