PROJECT SUMMARY This K23 application is submitted by Grace Richter, MD, MPH, an Assistant Professor of Ophthalmology in the Glaucoma Division at the USC Roski Eye Institute at Keck School of Medicine of University of Southern California. The primary objectives of this K23 career development proposal are: 1) to provide an academic glaucoma specialist with the additional training and mentored research experience necessary to direct clinical studies independently; and 2) to perform cross-sectional research investigating the relationships of various retinal microcirculation perfusion parameters with primary open angle glaucoma (POAG), systemic vascular disease, and ocular anatomic factors in African Americans, who have a greater burden of POAG compared to other populations. Together, this will provide the foundation for me to establish an independent clinical research program using optical coherence tomography angiography (OCTA) to study factors that affect OBF and to elucidate how OBF affects glaucoma in an R01-sponsored longitudinal clinical study. While I already have a Masters in Public Health (MPH), this K23 training program will provide additional necessary training for this research. My training efforts will focus on four areas: (1) vessel quantification methods using OCTA; (2) methods in population-based and clinical cohort studies; (3) advanced biostatistical methods for epidemiology and clinical research; and (4) best research practices in diverse populations. In addition to formal coursework, training will be greatly enhanced by regular meetings with renowned mentors (Dr. Rohit Varma, Dr. Ruikang Wang, Dr. James Gauderman, and Dr. Roberta McKean-Cowdin), as well as participation in local and international meetings. This research proposal will utilize OCTA data collected on participants of the African American Eye Disease Study to define the relationships of 4 different measures of retinal perfusion with: (1) glaucoma, including both structural and functional measures; (2) systemic vascular diseases including diabetes and hypertension; and (3) ocular anatomic features including intraocular pressure, central corneal thickness, and axial myopia in glaucoma and non-glaucoma patients. These systemic and ocular factors are thought to be risk factors for glaucoma, but the underlying mechanisms are not well understood. Defining the relationships of these entities with retinal perfusion parameters will give us better insight into the pathogenesis of glaucoma and will generate improved hypotheses for glaucoma pathophysiology. This research will provide key data for subsequent longitudinal studies and generate refined hypotheses for possible interventional studies. Ultimately, it will lead to improved treatments that prevent blindness from glaucoma.