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GLAUCOMA

PRESENTED BY SHRUTI MISHRA REG.N. 11408038 4TH YEAR B.TECH GENETIC ENGINEERING

INTRODUCTION
HUMAN EYE

1.Human eye is the organ which gives us the sense of sight.


2.It allows us to interpret shapes, color, dimensions of objects by processing the light they reflect.

Anatomy of human eye 1. Cornea 2. Pupil 3. Iris 4. Lens 5. Aqueous humor 6. Retina 7. Optic nerve 8. Vitreous humor

HOW A NORMAL EYE FUNCTIONS


Light waves from an object enter the eye first through the Cornea and then progress through the Pupil. Initially, the light waves are first converged by cornea then further by the lens. The light continues through the vitreous humor and then clear focus on the Retina. Within the layers of Retina, the light impulses changed into elecrtical signals . Then they are sent through the Optic Nerve to the posterior of the brain. Here these signals are interpreted by the brain as avisual image.

WHAT IS GLAUCOMA?
Glaucoma is an eye disorder in which optic nerve suffers damage, permanently damaging the vision of the affected eye and leads to complete blindness if untreated. Most of the forms of Glaucoma are age related, beginning in

midlife and progressing slowly but if detected early enough then the
Progression can be slowed by drug or surgical teatment.

CAUSE OF GLAUCOMA
Glaucoma mostly occurs due to increased pressure of aqueous humor that is Intraoccular Pressure(IOP) in the eye.

Intra occular pressure: It is the fluid pressure inside the eye and its normal pressure range varies from 10mmHg 20mmHg.

CAUSE OF GLAUCOMA CONTD


Aqueous humor is formed by Ciliary body and removed by Trabecular outflow Pathway in order to maintain the minimum level of pressure. For normal IOP, Rate of formation of fluid = Rate of removal of fluid. But in Glaucoma conditions the removal rate declines.

HISTORY
1. The first recognition of Glaucoma came with Richard Banister in 1622. 2. In the year 1613 it was reaccounted by Beer. 3. Five years later it was described as rainbow color and hardness of the eye , by Demours.

4. In the year 1829, Sir William Lawrence, after many years of research introduced the term Acute Glaucoma.
5. Year 1857: Von Grefe worked on the diagnosis of Glaucoma

TYPES OF GLAUCOMA
The most common types of Glaucoma are Primary Glaucoma 1. Open Angle Glaucoma 2. Closure Angle Glaucoma Other types of Glaucoma are: Secondary Glaucoma Neovascular Glaucoma Toxic Glaucoma

1. Open angle Glaucoma: This is associated with the increased pressure caused due to Trabecular blockage. In this type the aqueous humor can not drains out and leads to high pressure.
2. Closure angle Glaucoma: This is caused by contact between iris and trabecular meshwork. Due to this contact permanent obstruction of aqueous out flow occurs. 3. Secondary Glaucoma: It occurs due to some medical complications like eye surgeries , eye injuries, eye tumors, diabetes or use of corticosteroid drugs.

4. Neovascular Glaucoma: Neovascular glaucoma results when new, abnormal vessels begin developing in the angle of the eye that begin blocking the drainage.

5. Toxic Glaucoma:

It is open angle glaucoma with an unexplained significant rise of Intaoccular pressure following unknown pathogenesis.

SYMPTOMS
1. Progressive visual field loss 2. Optic nerve changes 3. Sudden occular pain

4. Seeing halos around light


5. Red eye

6. Very high intraoccular pressure


7. A fixed and mid dilated pupil 8. Nausia and vomiting
Seeing halos around light

PREVELENCE
Glaucoma in India : Glaucoma is the third leading cause of blindness in India

12 million people are affected accounting for 12.8% of the countries blindness
Population based studies report a prevalence between 2 to 13 %

PREVELENCE OF GLAUCOMA IN INDIA OVER OTHER EYE DISEASES

PREVELENCE OF GLAUCOMA IN CHENNAI


Prevalence of primary open angle glaucoma in the rural
population was 1.62%. The prevalence increased with increasing age .

Prevalence of primary angle closure disease in the rural population: 1.58%

GENETIC BASIS
Major genes involved in Glaucoma are TIGR (Trabecular meshwork induced glucocorticoid response protein ) , myocilin (MYOC) and optineurin (OPTN). Mutations in these genes cause Open angle Glucoma. TIGR and MYOC genes include three separate mutations that include Gly35Val, Gln361STOP, Tyr430His at chromosome 1q2131.(GLC1A) Mutation found in OPTN gene is alteration of its sequence at chromosome 10.(GLC1E)

TIGR gene: This gene encodes for TIGR protein which help in induction of out flow of aqueous humor in the eye. Mutation in this causes obstruction in outflow of aqueous humor hence leads to high IOP.

MYOC gene: This gene codes for Myocilin protein. Myocilin is an extracellular protein of unknown ocular function. In this gene gain of function mutation occurs which result in reduction of solubility of protein, causing it to aggregate in ER and preventing its secretion to ECM which in turn causing elevation in IOP and hence causes the disease.

OPTN gene: This gene codes for Optineurin protein. This gene may influences the regulated ganglion cell apoptosis . But mutation causes unregulated cell apoptosis that is Glaucoma associated cell apoptosis .

DIAGNOSIS
Screening for glaucoma is usually performed as part of a
standard eye examination performed by ophthalmologists.

This method include measurement of IOP by Tonometry.

GOLDMAN TONOMETER

TREATMENT
Techniques used for Glaucoma treatments are:
1. Medication 2. Surgery 3. Genetherapy 4. Stem cell therapy

1. Medication:
Types of medication include:

Alpha adrenergic agonist: Eg. Brimonidine, epinepherine Beta blockers : Eg. Betatoxol , timolol
Carbonic anhydrase inhibitors Eg. Dorzolamide, brinzolamide

2. Surgery:
This include following methods:

Trabeculectomy Peripheral iridectomy Goniotomy Trabeculotomy Laser therapy: Trabeculoplasty

3. Gene therapy:
In this method non functional gene will be replaced by functional gene by targeting the funtional gene to its particular target tissue like trabecular meshwork with the help of viral and non viral vectors.It also include target of neurogenerative growth factors.

4. Stem Cell based therapy:


The method involves taking stem cells from bone marrow and injecting them in a solution into the back of the eye.
There, they help existing optic nerve cells from degenerating further. They can also transform these cells into new optic nerve cells, reversing damage and improving eyesight.

INSTITUTIONS
Institutes conducting researches on Glaucoma in US are: 1. Glaucoma research foundation 2. American health assistance foundation 3. National Institute of Health Institutes conducting researches on Glaucoma in India are: 1. Shankar Netralay 2. Fortis Mohali Hospital 3. Glaucoma society of India