A groundbreaking partnership between the University of Sydney and the Snow Medical Research Foundation (Snow Medical) aims to transform the treatment of glaucoma, and related diseases of the optic nerve. Via an integrated research and innovation program, The Snow Vision Accelerator will develop new therapies that increase optic nerve resilience to prevent nerve and vision loss caused by glaucoma. This represents the largest coordinated, product-focused initiative ever undertaken in Australia to tackle vision loss from glaucoma.

WRITERS Anupam Unnati Sahay and Christopher Elasi

Glaucoma affects around 80 million individuals globally, and with 4.5 million people blind in both eyes, is the leading cause of irreversible blindness worldwide.

Glaucoma results from the accelerated loss of retinal ganglion cells, the nerve cells that transmit the visual message along the optic nerve from the retina to the brain. Also known as the ‘sneak thief of sight’, most individuals are unaware that they have glaucoma until very late stages of the disease, when well over 50% of the nerve has been lost. Elevated intraocular pressure (IOP), advancing age, and a family history of glaucoma are three major risk factors. Current treatments only address one of these risk factors: the lowering of IOP. This slows the rate of vision loss but does not stop it.

Professor Jonathan Guy Crowston is leading the Snow Vision Accelerator, a program that aims to broaden our knowledge and approach to managing glaucoma.

“The effect of advancing age, which makes the optic nerve more vulnerable to eye pressure, has historically been overlooked because the underlying biological causes have been considered non-modifiable,” he explained. “Advances over the past two decades have shown that biological ageing can be slowed and the associated vulnerability to disease reversed.

“The Snow Vision Accelerator will investigate how ageing and metabolic dysfunction render the optic nerve more vulnerable to glaucoma and, from this, develop a targeted drug discovery and development platform that will generate new treatments that reverse age-related declines in mitochondrial function and energy production, to boost optic nerve resilience to eye pressure.”

ALIGNED AMBITIONS

The partnership between the University of Sydney and Snow Medical makes perfect sense. Snow Medical’s principles underpin the funding and strategic direction of the Snow Vision Accelerator, which align closely with University of Sydney’s aspirations for excellent research that addresses the greatest challenges and contributes to the common good.

These principles champion high-risk, high-reward, long-term science with transformative potential for health and medicine, and they guide the Snow Vision Accelerator’s commitment to bold, agile, and milestone-driven research.

The program has four platforms:

Biology. Conduct pre-clinical research into the impact of advancing age, mitochondrial and metabolic dysfunction on optic nerve resilience to glaucoma.

Pathway discovery. Integrate data from multiomic cell and tissue analysis to identify novel pathways that inform new therapeutic targets for protecting the optic nerve in glaucoma.

Translation accelerator. Based at the Monash Institute of Pharmaceutical Sciences, this platform designs, optimises, and translates candidate small molecules and RNA therapies into clinical trial-ready assets.

Clinical. Develop designs for faster and more affordable clinical trials and establish a major patient cohort (comprising 1,000 recruited glaucoma patients) to guide biomarker development and have a ready pool of well-characterised patients to speed up clinical trial recruitment.

THE BIOLOGY PLATFORM

The Biology Platform is developing new ways to address the metabolic dysfunction that leaves the optic nerve and retinal ganglion cells (RGCs) vulnerable in glaucoma. These cells are among the most energy-demanding in the body. They work close to their energy limits, and that balance becomes even more fragile with age or increased eye pressure.

Lowering eye pressure is an effective way to slow glaucoma, but it cannot stop the disease. Long-term protection of vision requires treatments that directly strengthen the resilience of RGCs and the optic nerve.

The platform is co-led by Dr Andrea Loreto, Research Fellow at the University of Sydney, and Professor Robert Casson, clinician scientist at the University of Adelaide. They coordinate the work of several laboratories that share the common goal of boosting RGC energy metabolism to help these cells withstand stress. Their approaches include restoring mitochondrial health, supplying key molecular building blocks for energy production, reprogramming metabolic pathways, and using photobiomodulation to support mitochondrial performance.

Dr Loreto leads research on vitamin B3 metabolism and NAD+ (the oxidised state of nicotinamide adenine dinucleotide), an essential pathway known to become impaired in glaucoma. His work builds on current clinical trials that have shown promising results. The aim is to refine how NAD dysfunction is corrected and to develop the next generation of neuroprotective therapies for glaucoma.

Dr Katharina Bell, Senior Lecturer at the University of Sydney, in collaboration with Professor Christina Behl, a leading expert in Alzheimer’s disease research from the University of Mainz in Germany, will together target mitochondrial quality control that becomes dysregulated with advancing age.

Dr Volker Patzel, currently at the National University of Singapore, is developing mitochondria-targeting ribonucleic acid (RNA) therapeutics to modify genetic mutations associated with Leber’s hereditary optic neuropathy.

Associate Professor Benjamin Sivyer, currently at the Save Sight Institute within the Faculty of Medicine and Health at the University of Sydney, is investigating how retinal circuits process visual information and how these processes are altered by disease. His research combines electrophysiology, neuronal imaging, and molecular tools to reveal how retinal ganglion cells encode the visual world and how these cells succumb to injury in conditions such as glaucoma.

Prof Casson has a number of roles in this program. His lab is investigating how RGCs generate and use energy within their retinal ‘bioenergetic ecosystem’. His team has shown that bipolar and glial cells can export lactate to fuel RGCs under stress. Working with collaborators, Prof Casson is designing CRISPR-based constructs to reprogram retinal metabolism and exploring pharmacological ‘bioenergetic reprogramming’ using repurposed drugs to accelerate clinical translation.

In partnership with his collaborators, Prof Casson’s lab is also examining how photobiomodulation restores mitochondrial performance and reduces oxidative stress in RGCs. The aim is to develop a safe, noninvasive therapy that strengthens the optic nerve against glaucomatous injury.

Beyond these experimental therapies, Prof Casson is collaborating with Professor Kishan Dholakia, Head of Adelaide’s Centre of Light for Life, to develop Raman spectroscopy as a non-invasive tool to measure vitreal and retinal metabolites in vivo.

These combined efforts of the Snow Vision Accelerator Biology Platform signal a move beyond lowering eye pressure alone toward addressing the underlying processes that damage retinal ganglion cells and the optic nerve. The ultimate goal is to develop treatments to protect these cells and preserve sight for the long term.

PATHWAY DISCOVERY AND BIOINFORMATICS PLATFORM

The Pathway Discovery and Bioinformatics Platform is led by Professor Jean Yang and Associate Professor Heejung Shim from the University of Sydney. This platform provides the computational infrastructure to accelerate glaucoma research by systematically integrating publicly available datasets with new experimental multiomic analyses to generate new biological insights. In partnership with the Sydney Precision Data Science Centre, the platform will strengthen Australia’s vision bioinformatics capability and expand advanced analytics to fast-track the discovery of novel therapeutic pathways. This work is organised across three interconnected streams: data infrastructure, knowledge generation, and interdisciplinary communication.

Glaucoma is a heterogeneous disease influenced not only by intraocular pressure but also by metabolic health, mitochondrial function, inflammation, and ageing. The data-infrastructure stream will leverage transcriptomic, proteomic, metabolomic, and imaging datasets already available in public repositories, spanning human tissues, animal models, and cell systems. It will focus on identifying, downloading, curating, and harmonising these multiomics datasets to build a comprehensive vision data resource. This resource will then be integrated with newly generated in-house data to enable more robust detection of biological signals and increase confidence in prioritising therapeutic targets.

The knowledge-generation stream is designed to be modular and scalable, creating interdisciplinary projects of varying length and complexity, from short summer scholarships to full PhD programs. This will allow students to be strategically matched to projects based on their backgrounds and interests. For example, clinical students will work with patient-focused data, while statistics students will tackle computational challenges. Results and insights from this stream will be continuously documented in shared repositories, enabling sustained interdisciplinary learning and collaboration.

The communication stream will complement the other two streams by establishing a web-based interface that leverages cloud repositories and agentic generative AI to deliver interactive dashboards, supporting reproducibility and user-friendly data exploration. This stream will work closely with Snow Vision Accelerator’s clinical and biological programs to enable a rapid, data-driven workflow that links public data insights to translational opportunities.

TRANSLATION ACCELERATOR PLATFORM

The Snow Vision Accelerator Translation Platform, led by Professor Susan Charman and Dr Russell Tait, both based at the Monash Institute of Pharmaceutical Sciences, involves a partnership between the University of Sydney and Monash Institute of Pharmaceutical Sciences.

Acceleration will be achieved by bringing together world-class clinicians and biologists with experienced drug discovery and development scientists to deliver new drugs and treatments through discovery, development and into clinical evaluation. The platform will use a patient- and product-focused approach to set key project objectives and milestones that ensure rapid progression from initial drug discovery, through selection of a drug candidate, and into critical investigational new drug-enabling studies of a drug product suitable for clinical evaluation.

This stream aims to develop a pipeline of three to five initial targets with staggered project entry into the translation process. Projects will originate through leading Australian and international research groups actively pursuing new approaches to improve the resilience of the optic nerve during ageing.

This high-risk/high-reward venture will be guided by an operational and governance framework focused on integration of key disciplines, drug asset development, and delivery of outcomes.

Snow Medical Research Foundation’s significant investment provides a unique opportunity to accelerate translation of drug candidates to a clinic-ready endpoint, ensuring that development is not interrupted by the constant need to raise further capital separately at each step. In doing so, candidates will be developed more rapidly and, in turn, be more commercially attractive for further investment. Assets emerging from the program are anticipated to be more valuable to potential follow-on investors and strategic partners, have a much greater likelihood of completing subsequent clinical trials, and will ultimately provide new therapies for patients.

CLINICAL PLATFORM

The Snow Vision Accelerator clinical platform, led by Dr Bell and Dr Ridia Lim from the University of Sydney, will establish a collaborative framework for improving neuroprotective treatment trials.

At its centre is OMEGA – a large, longitudinal observational cohort study that will follow 1,000 people with open-angle glaucoma alongside participants with other optic neuropathies and healthy controls across Australia and New Zealand. Glaucoma is a heterogeneous optic neuropathy, and while elevated intraocular pressure is the major modifiable risk factor, emerging evidence suggests that systemic metabolic health, ageing, and individual resilience may also influence susceptibility and progression.1-4

Researchers from the Snow Vision Accelerator program.

Many patients exhibit subtle physiological or metabolic alterations that may compromise optic nerve recovery and accelerate progression, even when pressure is well controlled. By integrating detailed clinical assessments with molecular and metabolic profiling, OMEGA aims to define distinct patient subtypes and identify modifiable biological pathways that could inform more targeted and personalised therapies. Insights from this work are expected to refine risk prediction tools and, over time, guide a shift toward a more individualised, mechanism-based approach to glaucoma management – serving as an adjunct to intraocular pressure lowering.

In parallel, the clinical platform is addressing inequity in ophthalmology research by expanding trial participation beyond metropolitan centres. Conducted within Australia, this work will explore new models for decentralised clinical trials, including the involvement of regional and community-based sites, and the feasibility of home-based visual field monitoring, to make research participation more accessible for rural and remote populations. These initiatives will help ensure that future treatments are tested in – and ultimately reach – the diverse communities they are intended to serve. Looking ahead, the Snow Vision Accelerator will unite international partners in a dedicated neuroprotection consortium to harmonise early-phase trial design.

The clinical platform works in close alignment with Snow Vision Accelerator’s biology, drug discovery and data science streams, ensuring that promising metabolic or neuroprotective candidates emerging from laboratory research can be rapidly evaluated in a well-characterised patient population – creating a direct pathway from discovery to improved vision care.

Anupam Unnati Sahay is the Head of Operations at the Snow Vision Accelerator, within the Faculty of Medicine and Health at the University of Sydney.

Christopher Elasi is a Project Manager at Snow Medical. He has responsibilities in managing the Transformation Program projects, including the Snow Centre for Immune Health and Snow Vision Accelerator.

Ms Sahay and Mr Elasi acknowledge contributions to this article provided by the below members of Snow Vision Accelerator team.

Professor Jonathan Crowston MBBS FRCOphth FRANZCO PhD, Director of the Snow Vision Accelerator within the Faculty of Medicine and Health at the University of Sydney.

Professor Robert Casson MB BS (Hons) MBiostatistics DPhil FRANZCO from Adelaide University, who is a Principal Investigator and co-lead of the Biology Platform at the Snow Vision Accelerator.

Dr Andrea Loreto Bsc Msc PhD, a Research Fellow at the School of Medical Sciences within the Faculty of Medicine and Health at the University of Sydney. Dr Loreto is a Principal Investigator and co-lead of the Biology Platform at the Snow Vision Accelerator.

Dr Volker Patzel PhD MBA, a Senior Lecturer at the National University of Singapore and a Principal Investigator of the Biology Platform at the Snow Vision Accelerator.

Associate Professor Benjamin Sivyer PhD from the Save Sight Institute within University of Sydney, is a Principal Investigator of the Biology Platform at the Snow Vision Accelerator.

Professor Jean Yang PhD from the School of Mathematics and Science at the University of Sydney, who is the Director of the Sydney Precision Data Science Centre and a Principal Investigator and lead of the Pathway Discovery Platform at the Snow Vision Accelerator.

Associate Professor Heejung Shim from the School of Mathematics and Science at the University of Sydney who is a Principal Investigator of the Pathway Discovery Platform at the Snow Vision Accelerator.

Professor Susan Charman from the Monash Institute of Pharmaceutical Sciences (MIPS). She is the former Director of the Centre for Drug Candidate Optimisation (CDCO), and a Principal Investigator and co-lead of the Translation Accelerator Platform at the Snow Vision Accelerator.

Dr Russell Tait Bpharm PhD MBA, Director Enterprise and Engagement at Monash University within the Faculty of Pharmacy and Pharmaceutical Sciences. Dr Tait is a Principal Investigator and colead of the Translation Accelerator Platform at the Snow Vision Accelerator.

Dr Katharina Bell MD PhD FEBO, a Senior Lecturer at the NHMRC Clinical Trials Centre within the Faculty of Medicine and Health at the University of Sydney. Dr Bell is a Principal Investigator within the Biology Platform as well as lead for the Clinical Trials Platform.

Dr Ridia Lim MB BS MPH FRANZCO, who is a senior ophthalmologist, glaucoma sub-specialist and head of the glaucoma unit at Sydney Eye Hospital. Dr Lim is a Principal Investigator for the Clinical Trials Platform.

References available at mivision.com.au.