Redefining clinical outcomes and endpoints in glaucoma

Abstract

Introduction: Increasing life expectancy and ageing populations across the world are causing the number of glaucoma patients to rise dramatically. With longer lifespans also comes the need to improve the timeframe and accuracy with which we can diagnose, monitor and treat patients, ensuring longevity of vision contributes to a meaningful quality of life. Current markers used in glaucoma practice are in many cases suboptimal in their ability to accurately identify glaucomatous damage in time to prevent irreversible optic neuropathy. Areas covered: This review summarises the important properties of successful biomarkers and surrogates, and relates this to how intraocular pressure, visual field testing, and imaging have been refined to improve early diagnosis and progression analysis of glaucoma patients. Secondly, we discuss newer concepts in imaging, genetics, and objective measures which may provide biomarkers and surrogate endpoints with which to develop novel treatments in the future. Expert Commentary: We summarise the key relevant points in glaucoma research, and the current techniques being trialled that are most likely to lead to valuable biomarkers for the future.

Measures of disease activity in glaucoma

“…When the RGCs undergo apoptosis, more PS starts to appear on the outer leaflet (Figure 14) (Ahmad 2017;Yap et al 2020b). DARC is a technique that allows the identification and visualisation of apoptosing RGCs by using fluorescently labelled annexin A5 (Yap et al 2018b). Annexins use calcium (Ca 2+) to bind to phospholipids.…”