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Genes contributing to glaucoma may influence intraocular pressure elevation and/or susceptibility of the optic nerve to degeneration. To date, five genes/genomic regions have been statistically associated with primary open-angle glaucoma (POAG): the CAV1/ CAV2 genomic region on chromosome 7, CDKN2BAS, the SIX1/ SIX6 genomic region on chromosome 14, TMCO1, and a regulatory region on chromosome 8q22. While all of these regions were initially identified as associated with POAG or normal-tension glaucoma (NTG), several of them have been further associated with specific features of the disease; for example CDKN2BAS, SIX1/SIX6 and the 8q22 region all appear to impact optic nerve susceptibility to degeneration. In this paper by Sharma et al., evidence is provided to suggest that TMCO1 risk alleles modify the age of disease onset and that this may occur because TMCO1 risk allele carriers have higher IOP. TMCO1 was initially identified as a glaucoma susceptibility gene in a genome-wide association study using 590 severely affected POAG patients and 3,956 controls.1 Subsequently, a genome-wide association study found that TMCO1 was statistically associated with IOP.2 Ocular expression studies included in the Sharma et al., study demonstrate TMCO1 expression in the retina, optic nerve, lamina cribrosa, ciliary body and trabecular meshwork, suggesting that the protein may have roles in both regulation of IOP and in susceptibility to optic nerve disease in glaucoma. Interestingly, TMCO1 loss of function mutations cause an autosomal-recessive syndrome which includes mental retardation, dysmorphism, skeletal and neurological findings, suggesting a role for the protein in cortical development and other developmental processes.3 The function of the protein product of TMCO1 is unknown. Some studies suggest that the protein may co-localize with endoplasmic reticulum while others suggest the protein is associated with mitochondria.4 Further investigations defining the role of TMCO1 in regulation of IOP and/ or age of onset of glaucoma will be of great interest.