Efficacy of Simbrinza and Rocklatan vs Cosopt and Latanoprost

Inclusion criteria:

• Adults aged Eighteen (18) years and older with a diagnosis of mild to moderateopen-angle glaucoma (OAG), currently on an on-label use of combination topicalmedication of Cosopt and Latanoprost for a minimum of 1 month. Evidence of opticnerve damage will be based on AAO Preferred Practice Patterns guidelines usingeither or both of the following:

• Optic disc or retinal nerve fiber layer (RNFL) structural abnormalities

• Diffuse or focal narrowing, or notching, of the optic disc rim, especially at theinferior or superior poles, which forms the basis for the ISNT rule

• Progressive narrowing of the neuroretinal rim with an associated increase in cuppingof the optic disc

• Diffuse or localized abnormalities of the parapapillary RNFL, especially at theinferior or superior poles

• Disc rim, parapapillary RNFL, or lamina cribrosa hemorrhages

• Optic disc neural rim asymmetry of the two eyes consistent with loss of neuraltissue

• Large extent of parapapillary atrophy

• Reliable and reproducible visual field abnormality considered a valid representationof the subject's functional status

• Visual field damage consistent with RNFL damage (e.g. nasal step, arcuate fielddefect, or paracentral depression in clusters of test sites)

• Visual field loss across the horizontal midline in one hemifield that exceeds lossin the opposite hemifield (in early/ moderate cases)

• Absence of other known explanations (e.g. optic disc drusen, optic nerve pit)

• Mean diurnal IOP ≥ 18 mmHg and < 28 mmHg at baseline in at least one eye with aninter-eye IOP difference < 5 mmHg.

• A central corneal thickness (CCT) within the range of 450-650 µm

Exclusion criteria:

• Patients with prior ocular procedures or intraocular surgery within 1 year prior tobaseline (e.g. cataract surgery).

• Patients with prior history of glaucoma surgeries or laser treatment except patientswith history of SLT >1 yr prior to baseline.

• Contraindications or known hypersensitivity to any or all the study medicationsincluding Rocklatan, Simbrinza, Cosopt and Latanoprost or related class of drugs.

• Patients with known history or presence of uncontrolled systemic diseases includingdiseases that, in investigator's opinion, may make it unsafe or undesirable for thesubject to participate in the study and/ or limit adherence.

• Patients with known history or presence of significant ocular diseases includingcorneal diseases, dystrophies or abnormalities that would prevent accurate IOPreadings with GAT.

• Patients with a history of uncontrolled IOP with the combination of either Rocklatan

• Simbrinza or Cosopt + Latanoprost dual therapy.

• Significant ocular surface findings (e.g. hyperemia, irritation) found during slitlamp examination that might affect the study.

• Chronic use of any systemic medication for chronic diseases that may affect IOP.

• Subjects who are pregnant, lactating or planning a pregnancy.

• Any condition in the opinion in the investigator that would potentially confound theresults of this study