Polygenic Risk-Enhanced Detection and Initiation of Glaucoma Treatment: Feasibility Study

RAPID GLAUCOMA EVALUATION CLINIC Eligible participants will be invited to a Rapid Glaucoma Evaluation Clinic (RGEC) where they will: 1. Undergo diagnostic examinations (Visual Acuity, Automated Refraction, automated perimetry, intraocular pressure (IOP) and corneal thickness measurement, optical coherence tomography of the anterior segment, macula and optic nerve head, and colour fundus photography) 2. Provide a saliva swab for a NATA-accredited glaucoma polygenic risk score (SightScore) RISK STRATIFICATION PHASE The collected diagnostic information will be inputted into a combined clinical-polygenic risk calculator which will provide a 5 year percentage risk estimate of treatment initiation. The participants will be informed of their risk stratification within 4 to 6 weeks of clinic attendance and instructed on the designated follow-up pathway: - High Risk: allocated to a glaucoma subspecialty clinic waitlist - Intermediate/Medium Risk: reviewed every 6 months in a dedicated glaucoma monitoring clinic - Low Risk: reviewed every 12 months in a dedicated glaucoma monitoring clinic FOLLOW UP PHASE Once the stratification and allocation to care pathway has been completed, clinical care of participants is at the discretion of the clinician. However, all participants will remain enrolled for 24 months from time of enrolment, and their notes from each subsequent clinical visit reviewed for evidence of conversion to glaucoma, defined as the development of a reproducible glaucomatous visual field defect, reproducible IOP > 28 mmHg or reduction in circumpapillary retinal nerve fibre layer (RNFL) thickness of >10% from baseline in either superior or inferior quadrant.