The cholinergic system has a crucial role to play in visual function. Although cholinergic drugs have been a focus of attention as glaucoma medications for reducing eye pressure, little is known about the potential modality for neuronal survival and/or enhancement in visual impairments. Citicoline, a naturally occurring compound and FDA approved dietary supplement, is a nootropic agent that is recently demonstrated to be effective in ameliorating ischemic stroke, traumatic brain injury, Parkinson's disease, Alzheimer's disease, cerebrovascular diseases, memory disorders and attention-deficit/hyperactivity disorder in both humans and animal models. The mechanisms of its action appear to be multifarious including (i) preservation of cardiolipin, sphingomyelin, and arachidonic acid contents of phosphatidylcholine and phosphatidylethanolamine, (ii) restoration of phosphatidylcholine, (iii) stimulation of glutathione synthesis, (iv) lowering glutamate concentrations and preventing glutamate excitotoxicity, (v) rescuing mitochondrial function thereby preventing oxidative damage and onset of neuronal apoptosis, (vi) synthesis of myelin leading to improvement in neuronal membrane integrity, (vii) improving acetylcholine synthesis and thereby reducing the effects of mental stress and (viii) preventing endothelial dysfunction. Such effects have vouched for citicoline as a neuroprotective, neurorestorative and neuroregenerative agent. Retinal ganglion cells are neurons with long myelinated axons which provide a strong rationale for citicoline use in visual pathway disorders. Since glaucoma is a form of neurodegeneration involving retinal ganglion cells, citicoline may help ameliorate glaucomatous damages in multiple facets. Additionally, trans-synaptic degeneration has been identified in humans and experimental models of glaucoma suggesting the cholinergic system as a new brain target for glaucoma management and therapy.

胆碱能系统在视觉功能中发挥着至关重要的作用。尽管胆碱能药物作为降低眼压的青光眼药物已成为人们关注的焦点，但人们对神经元存活和/或视力障碍增强的潜在方式知之甚少。胞二磷胆碱是一种天然化合物，已获得 FDA 批准的膳食补充剂，是一种促智剂，最近被证明可有效改善缺血性中风、创伤性脑损伤、帕金森病、阿尔茨海默病、脑血管疾病、记忆障碍和注意力缺陷/多动障碍在人类和动物模型中。其作用机制似乎多种多样，包括（i）保存磷脂酰胆碱和磷脂酰乙醇胺的心磷脂、鞘磷脂和花生四烯酸含量，（ii）恢复磷脂酰胆碱，（iii）刺激谷胱甘肽合成，（iv）降低谷氨酸浓度和预防谷氨酸兴奋毒性，(v) 拯救线粒体功能，从而防止氧化损伤和神经元凋亡的发生，(vi) 髓磷脂的合成，导致神经元膜完整性的改善，(vii) 改善乙酰胆碱的合成，从而减少精神压力的影响，以及 ( viii) 预防内皮功能障碍。这些作用证明了胞磷胆碱作为神经保护剂、神经恢复剂和神经再生剂。视网膜神经节细胞是具有长有髓轴突的神经元，这为胞二磷胆碱在视觉通路疾病中的应用提供了强有力的理论依据。由于青光眼是一种涉及视网膜神经节细胞的神经退行性疾病，胞磷胆碱可能有助于改善多个方面的青光眼损伤。此外，在人类和青光眼实验模型中已经发现了跨突触变性，表明胆碱能系统是青光眼管理和治疗的新大脑靶标。