Imaging the Effects of Netarsudil (Rhopressa) on the Trabecular Meshwork in Glaucoma and Ocular Hypertension

This study evaluates the effects of netarsudil (Rhopressa) on the trabecular meshwork in subjects with ocular hypertension or open-angle glaucoma. Participants will be randomized to receive either netarsudil or placebo (artificial tears). High-resolution imaging using adaptive optics gonioscopy, anterior segment optical coherence tomography (AS-OCT), and OCT gonioscopy will be performed at baseline and after approximately 14 days of treatment. The primary objective is to assess changes in trabecular meshwork lamellae spacing, with secondary measures including trabecular meshwork height, width, and Schlemm's canal diameter.

Inclusion Criteria: * Adults aged 18 years or older * Diagnosis of ocular hypertension or open-angle glaucoma * Eye examination within the past year * For glaucoma subjects: structural (optic nerve and/or retinal nerve fiber layer) and functional (visual field) findings consistent with glaucoma * Best-corrected visual acuity of 20/100 or better * Open anterior chamber angle as confirmed by gonioscopy and anterior segment optical coherence tomography (AS-OCT) * Intraocular pressure between 18 and 34 mmHg (treatment-naïve or after washout, if applicable) Exclusion Criteria: * Known intolerance to netarsudil ophthalmic solution * Corneal scarring or active corneal disease that would interfere with imaging * Inability to tolerate gonioscopy procedures * Females of childbearing potential who are not using effective contraception or are not sterile * Any condition that, in the opinion of the investigator, would place the subject at increased risk or interfere with study completion