Second protein causing hereditary NTG, Tank-binding kinase 1 (TBK1) relates

with OPTN gene while this interaction is amplified in an, optineurin mutant

(E50K) which shows that binding of the TBK1 to the mutant OPTN could stop

the protein from obstructing NFk β activation (Morton et al., 2008). The

protein known as ‘Cylindromatosis Turban Tumor Syndrome Protein’ which

is another negative obstructer of TNF α which brought NFk β initiation and

has also been revealed to relate with Optineurin protein as well as the

communication is also enlarged by the mutations of the OPTN gene

(Nagabhushana et al., 2011). Such outcomes express that TNF α brought NFk

β transcription which is harmful to the ganglion cells in Glaucoma as well as

the loss of inhibitors generally occurs to control this process that may result in

extreme familial optic nerve disorder (Wiggs, 2015).

Linkage investigations recognized 23 different loci for numerous forms of

Glaucoma like, GLC3A- GLC3B, GLC1L, 2p14, 10p12, p13, 2q33-q34, 14q11,

5q22.1-q32, 14q21-q22, 19q12-q14 and 17ps23 (Gemenetzi et al., 2012; Stone et

al., 1997). In dissimilarity, just few genes are presently responsible for this

disease which are; MYOC / TIGR, Optineurin, CYP1B1, OPTN as well as WD

recap 36 (Monemi et al., 2005). Some novel CYP1B1 mutations have been

recently identified. Consanguineous Pakistani families having primary

congenital Glaucoma. The leading cause of primary congenital Glaucoma in

Pakistani patients is CYP1B1 mutations (Rauf et al., 2016).

1.8 Diagnosis

Diagnosing glaucoma is not so easy. The main worry is to defend vision.

Physicians before taking treatment decisions for tonometry, utilize some eye
drops to make eyes emotionless. Doctor or a technician then make use of a

stratagem known as a tonometer to measure eye's internal pressure.

By using a specific minute device, low pressure is applied to the eye. The

usual pressure of eye varies between 12 to 22 mm Hg. Then some specific eye

drops are utilized to enlarge the pupil so doctor can observe shape as well as

color of optic nerve through eye with a certain lens, and this technique is

known as ophthalmoscopy. Perimetry provides visualization map which aids

an expert to determine that either a single vision has distressed by Glaucoma

or not. The ‘gonioscopy investigative examination which supports regulation

of open, closed or the thin position of iris of eye. Eye drops are utilized to

distress eye through the examination as well as for few minutes a separate

hand-held lens is placed slickly on eye. Pachymetry is a technique which

measures width of the cornea.

Thickness of the cornea have influence on the readings of the eye pressure.

Uncertainty of the corneal thickness than the normal pressure estimations can

be doneby a tonometer which gives excess evidence for glaucoma analysis by

your eye doctor (Khan et al., 2017).

1.9 Treatment

Treatment of glaucoma cannot correct the damage, but it can prevent the

disease to progress, so the sooner the patient is kept on treatment the quicker

it can be prevented from causing more harm. Thus, differentiating between

healthy eyes and glaucomatous eyes by measuring RNFL thickness may aid

in early detection of glaucoma suspects preventing future progression of the

disease (Mukhtar, 2016). Slowing down the disease development and

conservancy of quality of life are chief goals for the treatment of glaucoma.

The reduced quality of life is related with Glaucoma and can cause the disease

earlier than the normally thought old age. Similarly, avoiding the value of

early diagnosis as well as treatment can also add to the severity of the disease.

While the only verified effective way to treat Glaucoma is the reduction of the

intraocular pressure (Weinreb et al., 2014).

Present management strategies by the AAO has recommended the lowering

of the intraocular pressure to a targeted level, that is a value or the range of

several values at which the clinician would be certain of that the rate of the

disease development will be slow down satisfactorily to evade functional

impairment due to the disease. If the medical treatment does not show the

acceptable reduced intraocular pressure incisional surgeries or laser is

suggested. The per year incisional glaucoma surgeries has been calculated as

274 number of per million people in US (Mansouri et al., 2013).

Laser trabeculoplasty is a treatment that lowers the intraocular pressure in the

eye by bringing biological alterations in trabecular meshwork which results in

improved aqueous outflow. This treatment method has an outstanding safety

profile and is quite safe to be used. Though the extensive intraocular pressure

reduction can be attained in most of the patients still the effect declines

steadily with the passage of time having a failure rate of around 10%

annually. Trabeculectomy is performed most frequently as an incisional

surgical method to lesser the intraocular pressure. This method contains

removal of a minor part of trabecular meshwork or the subsequent

corneoscleral tissue in order to make available a drainage route for the

aqueous humor from within the eye to beneath the conjunctiva where it gets

absorb (Weinreb et al., 2014).

In this study, the data was recorded from various hospitals of district

Abbottabad as well as the risk factors related with Glaucoma were studied

also and role of Glaucoma in blindness is quantified. The sequence variation

in OPTN gene was analyzed in population of Abbottabad.

Objectives

The present study was designed to attain the following Objectives;

1. To obtain the history as well as prevalence of glaucoma in population

of the Abbottabad District.

2. To quantify the role of Glaucoma in blindness.