Glaucoma blindness intervention in our sights

In a world first, ophthalmology experts at Flinders University will trial an early intervention laser treatment that will prevent people at high risk of glaucoma from developing loss of sight from the disease.

Glaucoma is a disease linked to increased pressure inside the eye, which can cause irreversible damage to the optic nerve and loss of vision. It is asymptomatic in the early stages and is the leading cause of irreversible blindness worldwide.

Chief investigator Professor Jamie Craig, Matthew Flinders Distinguished Professor at the College of Medicine and Public Health, has been awarded more than $1.7 million by the NHMRC to explore the use of early intervention to prevent glaucoma related loss of vision for those at risk.

The trial will use an intervention laser treatment, selective laser trabeculoplasty (SLT), that has been proven to slow disease progression by lowering pressure inside the eye. The trial will determine the effectiveness and suitability of using SLT laser as an early intervention to prevent the onset of visual loss from glaucoma.

Professor of Ophthalmology Jamie Craig, who leads a major international glaucoma research program.

“We have developed a tool that can identify individuals who are deemed at high risk of losing their vision from glaucoma, however there is still a major gap between identifying them and how they may be safely treated. Early detection and treatment of those most at risk of vision loss is fundamental to reducing the disease burden for patients and the health care system,” says Professor Craig.

“This clinical trial will generate high-quality evidence to determine the effectiveness of a more timely delivery of laser for high-risk individuals. If effective, this will reduce visual issues and blindness from glaucoma which will improve their quality of life, allow them to continue working and driving, reduce their risk of falls and lead to cost savings for the health system,” adds Professor Craig.

The $1.7 million research project will use a randomised controlled trial of 500 genetically at-risk glaucoma suspects to determine the effectiveness of early laser treatment in preventing loss of vision. After receiving the laser treatment, participants will be monitored twice a year over a two-year period.

“Insights gained from this trial will have immediate implications for the monitoring and treatment of high-risk glaucoma patients, with the aim of preventing progressive vision loss and blindness both in Australia and internationally,”says Professor Craig.

The new project also involves other researchers from Flinders University, University of Tasmania, Macquarie University, University of Adelaide, Garvan Institute of Medical Research, Council of the Queensland Institute of Medical Research, University of New South Wales and George Institute for Global Health.

Professor Craig has made important discoveries on the genetic basis of glaucoma using a pioneering International Registry of cases of vision loss. This approach led to genome-wide association studies identifying multiple genes associated with glaucoma susceptibility. These discoveries are now moving into the clinic as risk profiling for individuals becomes a reality.

This project follows on from previous research by Professor Craig developing a glaucoma polygenic risk score (PRS) which effectively identifies individuals at high risk of becoming blind from glaucoma. It found that PRS is highly predictive of future vision loss and that new monitoring and treatment strategies such as the pre-emptive laser treatment are required.

The grant is one of 28 Clinical Trials and Cohort Studies grants announced this week by the Australia’s National Health and Medical Research Council (NHMRC).

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