1.1 The Glaucoma Research Unit has 2 programmes of research. The first of these (headed by Ted Garway-Heath) is looking at the phenotypic characteristics of the glaucomas and correlating these with the genotype. The second programme (headed by Professor Peng Khaw) is investigating the treatment of glaucoma including the modulation of wound healing. The programmes are collaborative with the Institute of Ophthalmology and other specialist eye units nationally and internationally, and follow the priorities set out in the Royal College of Ophthalmologists 5 year Strategy.

1.2. Our programme focused on phenotype and genotype has had some notable successes this year. We have identified a number of genetic changes specific for subsets of the glaucoma population. Progress in this area will allow us, in collaboration with molecular genetics laboratories in the UK and the USA, to develop specific kits for genetic diagnosis of glaucoma types. We look towards the time when this knowledge will help us tailor treatment to the individual patient. We have made progress in the detection of change in chronic glaucoma by quantifying the inherent variability of measurement methods. These investigations are moving the goal of assessing rate of change closer to clinical practice. This will improve measurement of the outcomes of treatment, and will allow the risk benefit ratio to be ascertained for the individual patient.

1.3 Our programme that looks at treatment has seen the rapid introduction of laboratory research into clinical practice with the CAT antibody used in modulation of wound healing being assessed first in a phase 2 and now in a European trial. This process, that took 4 years (and probably sets a record for this transition) is a realisation of the mission statement of the site (Better Science to Better sight). The MRC funded 5 fluoruracil trial continues to accumulate high quality data and will provide evidence of effect of differential intraocular pressures on the preservation of vision. The treatment / no treatment trial in normal pressure glaucoma will answer the question of whether preventative treatment for this glaucoma subset be recommended or not.

1.4 Most glaucoma is detected and referred by optometrists. We have undertaken research evaluating the performance of optometrists in glaucoma case detection and assessed the effect of specific training for this role. In addition, in the changing world of health-care provision, we have also undertaken and published research in the area of optometrists as co-managers of patients in hospital clinics.

1.5 The glaucoma service has continued to collect data on all the patients under its care. This audit has so far typified over 4500 patients, providing an unrivalled data source for clinical trials. One advantage in the possession of the database is that it allows instant recall of specific groups of patients should advances in treatment need to be communicated to the patient rather than wait for their re-attendance in the clinic.

1.6 This programme of work within the clinical glaucoma service is collaborative with many disciplines at the Institute of Ophthalmology and University College. However, to meet the challenge of developing a rational and cohesive ophthalmic research strategy to meet the needs of the NHS in the first instance, the Trust has developed an Ophthalmic Research Network, charting existing collaborative studies and establishing others for the future. The Ophthalmic Research Network web site has achieved over 700,000 hits and has won the 2001 Healthcare IT Effectiveness Award "Best publicly accessible health-related information systems". The clinical genetics programme has now extended to cover most of England, a multi-centre comparative study of surgical treatment is incorporating Europe and globally we are involved in studies of glaucoma in Kenya, Singapore, South America and Mongolia.

1.7 These approaches together with our extensive work identifying genetic linkages with glaucoma, will open the door for new therapies and a more comprehensive understanding of the disease.