To the clinic and back

Summary For a clinician, neuroprotection in glaucoma means “decreasing vision loss without affecting intra ocular pressure”. In recent years, translational research on neuroprotection has offered several molecules for clinical testing. Unfortunately, after evaluation via randomized clinical trials, their efficacy is still a matter of debate. We are presently left with excessive patients’ attrition, poorly defined outcomes, borderline significances, clinically unrelevant results etc. A re‐thinking of the general approach to the issue of neuroprotection in glaucoma is then necessary. The molecules, before being chosen for evaluation in humans, should offer a more striking and unquestionable pre‐clinical efficacy profile. New outcomes, on top of the traditional standard automatic perimetry, are needed in order to shorten the duration of the trials and to reduce the “noise” of the system. New study designs, properly tailored on neurodegenrations, together with new strategies for data analysis are needed: futility trials, Bayesian approach and adaptive study designs will extensively be discussed as potential tools to return from the bench to the bedsite.