Please select the eligibility criteria that correspond to the clinical trial below.
Title: Direct Selective Laser Trabeculoplasty (DSLT) In Open Angle Glaucoma (POAG): A Randomized Controlled Trial
Brief Summary: Glaucoma is an eye disease that results in damage to the optic nerve that progresses over time. One of the main risk factors in glaucoma is an increase in intraocular pressure, caused by a build-up of fluid in the eye. Glaucoma can result in blindness if left untreated and as such it is extremely important to diagnose and treat the condition.

Selective Laser Trabeculoplasty (SLT) is a laser treatment that facilitates the outflow of fluid from inside the eye. This has the potential of reducing the intraocular pressure within the eye (the main way in which this disease is treated since there is no cure) and may assist in helping to control the progression of this disease.

SLT (standard treatment) is a technique routinely carried out by glaucoma specialists. It is conducted using a special type of lens (goniolens) that gently sits on the front surface of the eye. The procedure takes approximately 5 minutes in duration.

This new treatment, Direct Selective Laser Trabeculoplasty (DSLT) is performed directly, without there being any need to use a goniolens which sits on the eye, and it is a shorter and simpler technique to conduct when compared to the standard SLT technique.

The purpose of this study is to assess the hypothesis that the treatment by new automated device for DSLT is not worse in comparison with the standard SLT and determine that it is effective in reducing intraocular pressure.


Options:
A: Inclusion Criteria:

* Age \> 18 year-old
* Patients who were diagnosed as primary open-angle glaucoma, normal tension glaucoma, and ocular hypertension either newly diagnosed or currently on medical therapy.
* Agree to participate in the study, accept to be randomized to receive treatment, and willing to sign an informed consent

Exclusion Criteria:

Related to the severity of disease and visual acuity status

* Advance glaucoma in the study eye
* Have a very high intraocular pressure that need immediate treatment to prevent retinal vein occlusion (intraocular pressure \>30 mmHg)
* Currently on maximal tolerated medical treatment and unable to control intraocular pressure
* Currently on oral carbonic anhydrase inhibitor for intraocular pressure control
* Single eye, the other eye blind from any cause

Related to surgical procedures

* Prior laser trabeculoplasty
* Prior glaucoma surgery
* Prior retinal surgery
* Underwent less than 3-month cataract extraction
* Potential need for other ocular surgery within the 2-3-month follow-up period since enrollment Related to underlying and ocular history
* History of diabetic retinopathy staged as severe non-proliferative or worse
* Narrow iridocorneal angle
* Ocular condition precluding visualization of trabecular meshwork
* Recently have ocular inflammation of any cause
* Previous history of ocular trauma
* Pregnant or breast-feeding women Related to the difficulty of having reliable measurements
* History of refractive surgery or any keratoplastic procedure
* Corneal opacities or diseases making no suitable tonometry
* Subjects with having poor or eccentric fixation or nystagmus
* Excessive eye squeezing
* Unable to lay down for measuring intraocular pressure in supine position during the night time
* Unable to have intraocular pressure checked every 2-hour such as have complicated underlying diseases or having sleep deprivation Related to allergy
* Known allergy to topical anesthesia
* Known allergy to fluorescein solution
* Known allergy to travoprost Related to compliance
* Impairment preventing adequate understanding to sign an informed consent
* Subject has demonstrated potential for non-compliance with the study protocol
* Unwilling to be randomized to receive treatment
* Unwilling to be washed out from currently treated drug(s).
B: Inclusion Criteria:

* glaucoma or ocular hypertension
* need for bilateral SLT

Exclusion Criteria:

* eye disease precluding accurate IOP measurement
* contraindication to topical prednisolone acetate
C: Inclusion Criteria:

* Over age of 18 yo.
* OAG including pigmentary dispersion syndrome and pseudoexfoliation
* OAG has been treated with 360 degrees of SLT
* two sighted eyes,
* willing to participate after being informed of and reading the patient information material.

Exclusion Criteria:

* Narrow angle glaucoma
* Previous glaucoma surgery
* Eye surgery expected in the next 12 months
* Severe corneal disease
* On or anticipated steroid in 6 months
* Pregnant or breast feeding
D: Inclusion Criteria:

1. Age 40 years or older, with visual acuity \> 6/60 in both eyes
2. Open angle glaucoma including exfoliative or pigmentary glaucoma or ocular hypertension
3. IOP ≥ 22mmHg to ≤35mmHg (after washout of any IOP-lowering medications)
4. Gonioscopically visible scleral spur for 360 degrees without indentation
5. Ability to visualize the peri-limbal sclera for 360 degrees (using a lid speculum)
6. Willing and able to participate in the 12-month study, to comply with the study procedures and to adhere to the follow-up schedule
7. Participant capable of giving informed consent

Exclusion Criteria:

1. Contraindications to conventional laser trabeculoplasty (e.g. corneal abnormalities, etc.)
2. Angle Closure Glaucoma
3. Congenital or developmental glaucoma
4. Secondary glaucoma except exfoliative or pigmentary glaucoma
5. Presence of any Peripheral Anterior Synechiae (PAS) in the study eye
6. Inability to conduct a reliable visual field (defined as fixation losses, false positives or false negatives greater than 33%)
7. Any of the following visual field findings using the Humphrey visual field analyzer the SITA-standard 24-2 program:

   1. A visual field MD of worse than -12dB
   2. Greater than or equal to 75% of points depressed below the 5% level and greater than or equal to 50% of points depressed below the 1% level on the PD plot
   3. At least 50% of points (i.e 2 or more) within the central 5 degrees with a sensitivity ≤0dB on the decibel plot
   4. Points within the central 5 degrees of fixation with a sensitivity \<15 dB in both hemifields on the decibel plot
8. A visual field MD of worse than -12dB in the fellow eye
9. Cup:Disc Ratio of more than 0.8
10. More than three hypotensive mediations required
11. Prior incisional or laser glaucoma surgery (including previous SLT) in the study eye
12. Prior corneal refractive surgery
13. Complicated cataract surgery ≤ 6 months prior to enrollment
14. Presence of visually significant cataract in the opinion of the investigator
15. Clinically significant disease in either eye as determined by the Investigator
16. Clinically significant amblyopia in either eye
17. Dense pigmentation or haemorrhage in the peri-limbal conjunctiva or anterior sclera
18. Women who are pregnant or may become pregnant during the study
19. In the opinion of the investigator the participant might require other ocular surgery within the 12-month follow-up period, unless for further reduction of their IOP
20. Concurrent treatment with topical, nasal, inhaled or systemic steroids
21. Uncontrolled systemic disease that could impact the ability of the participant to attend follow up visits as per the discretion of the investigator
22. Participation in another clinical study

Answer: D