New Clinical Study for Adults With Primary Open-Angle Glaucoma (POAG) or Ocular Hypertension (OH)
Thank you for your interest in this clinical research study for Primary Open Angle Glaucoma (POAG) or Ocular Hypertension (OHT). This set of questions will help us determine if you may be eligible to participate. The following questions will ask for specific and detailed information about your health, diagnosis, and medical history, as required by the study protocol. Your responses will be kept confidential and used solely to evaluate your potential eligibility for this study. Please answer each question as accurately as possible.
1. Are you 40 years old or older?
2. Have you ever been diagnosed by a healthcare professional with any of the following?
3. Are you currently using prescription eye drops to lower eye pressure?
4. Have you had eye surgery in the past 3 months?
5. Have you had a serious eye injury (trauma) in the past 6 months?
6. Have you ever been told you should not stop your glaucoma/eye pressure medication because it would be unsafe?
7. Have you ever been diagnosed with any of the following eye conditions?
8. Have you ever been told you have “advanced” glaucoma that threatens your central vision?
9. Are you currently pregnant, breastfeeding, or planning to become pregnant in the next few months?
10. Have you participated in another clinical trial and taken an experimental medicine within the past 6 weeks?
11. Would you be willing to temporarily stop your glaucoma/eye pressure drops for a short period (called a “washout”) if your doctor thinks it is safe?
12. This research study lasts for about 4–6 weeks and requires four consecutive visits to the study clinic. These visits will include eye pressure checks, eye imaging, eye drop treatments, and safety exams. Are you able and willing to commit to the full study duration and all required procedures?
Compliance & Consent Statement
By checking the box below and submitting this form, you acknowledge that you have read and understood the questions above and have answered them to the best of your ability.
You understand that this is a pre-screening questionnaire and does not guarantee your enrollment in the clinical study. A member of the research team will contact you to discuss your answers and potentially schedule a formal screening visit at the clinic, where final eligibility will be determined.
Consent to be Contacted:
By checking this box, you provide your express written consent for the study site and its research partners to contact you regarding this asthma research study and other clinical trial opportunities that may be of interest. You agree to be contacted via automated and manual phone calls, text messages, and/or email at the phone number and email address you provide, even if your number is on a do-not-call list. You understand that your consent is not a condition of receiving any treatment and that you can withdraw your consent at any time.
Unfortunately, you have not met the pre-screening requirements for this study.
Based on your answers, this clinical study may not be suitable for you. Each study has specific requirements to ensure participant safety.
Don’t lose hope! Each clinical study is different, and not qualifying for this one doesn’t mean you won’t qualify for another. Your doctor and care team may help you find a more suitable study.
Thank you for your time and interest.
You may contact us via email at clinicaltrials@responsumhealth.com
Congratulations, you’ve met the pre-screening requirements!
Based on your answers, you may qualify for this clinical study.
A representative from the study team will contact you within the next 1-3 days to connect you with a nearby trial site.
The trial doctor and site staff will provide more information about the study and can answer any questions you may have. If the trial doctor believes you may be a good candidate for the study, you will be invited to their clinic for a screening visit.
Participation is completely voluntary, and you can opt out at any time. If you no longer wish to be connected with a study doctor, please inform us by replying to this email.