A biomarker for fast progressors in glaucoma?

Glaucoma is a leading cause of irreversible blindness worldwide. The optic nerve damage it causes progresses at very different rates in different people — some patients lose vision quickly while others remain stable for decades. Identifying which patients are "fast progressors" early is crucial so that more aggressive treatment can be applied before significant vision loss occurs. This study is investigating whether a structural change called "lamina cribrosa deformation" — a bowing of the optic disc tissue visible on specialised imaging — can predict who is at highest risk of rapid vision loss. Patients with primary open-angle glaucoma (the most common form) will be randomly assigned to receive either additional eye pressure-lowering treatment or to continue at their current treatment level. Researchers will then track whether the patients with visible lamina cribrosa deformation benefit more from the extra treatment than those without it — helping to validate this imaging feature as a practical clinical tool. You may be eligible if you are 18 or older, have been followed for open-angle glaucoma for at least 36 months at Hong Kong Eye Hospital, are on no more than one pressure-lowering eye drop, and have not previously had glaucoma laser or surgical procedures. People with very high eye pressure, severe visual field loss, or diabetes affecting the eyes are not eligible. The study runs over two years with regular vision assessments.