Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Sep;48(7):903-914.
doi: 10.1111/ceo.13818. Epub 2020 Jul 28.

Improvement in inner retinal function in glaucoma with nicotinamide (vitamin B3) supplementation: A crossover randomized clinical trial

Flora Hui  1 , Jessica Tang  1   2 , Pete A Williams  3 , Myra B McGuinness  1 , Xavier Hadoux  1 , Robert J Casson  4 , Michael Coote  1   2 , Ian A Trounce  1   2 , Keith R Martin  1   2   5 , Peter van Wijngaarden  1   2 , Jonathan G Crowston  1   2   6   7
Affiliations
Randomized Controlled Trial

Improvement in inner retinal function in glaucoma with nicotinamide (vitamin B3) supplementation: A crossover randomized clinical trial

Flora Hui et al. Clin Exp Ophthalmol. 2020 Sep.

Abstract

Importance: Retinal ganglion cells endure significant metabolic stress in glaucoma but maintain capacity to recover function. Nicotinamide, a precursor of NAD+ , is low in serum of glaucoma patients and its supplementation provides robust protection of retinal ganglion cells in preclinical models. However, the potential of nicotinamide in human glaucoma is unknown.

Background: To examine the effects of nicotinamide on inner retinal function in glaucoma, in participants receiving concurrent glaucoma therapy.

Design: Crossover, double-masked, randomized clinical trial. Participants recruited from two tertiary care centres.

Participants: Fifty-seven participants, diagnosed and treated for glaucoma.

Methods: Participants received oral placebo or nicotinamide and reviewed six-weekly. Participants commenced 6 weeks of 1.5 g/day then 6 weeks of 3.0 g/day followed by crossover without washout. Visual function measured using electroretinography and perimetry.

Main outcome measures: Change in inner retinal function, determined by photopic negative response (PhNR) parameters: saturated PhNR amplitude (Vmax), ratio of PhNR/b-wave amplitude (Vmax ratio).

Results: PhNR Vmax improved beyond 95% coefficient of repeatability in 23% of participants following nicotinamide vs 9% on placebo. Overall, Vmax improved by 14.8% [95% CI: 2.8%, 26.9%], (P = .02) on nicotinamide and 5.2% [-4.2%, 14.6%], (P = .27) on placebo. Vmax ratio improved by 12.6% [5.0%, 20.2%], (P = .002) following nicotinamide, 3.6% [-3.4%, 10.5%], (P = .30) on placebo. A trend for improved visual field mean deviation was observed with 27% improving ≥1 dB on nicotinamide and fewer deteriorating (4%) compared to placebo (P = .02).

Conclusions: Nicotinamide supplementation can improve inner retinal function in glaucoma. Further studies underway to elucidate the effects of long-term nicotinamide supplementation.

Keywords: electroretinography; glaucoma; neuroprotection; nicotinamide; vitamin B3.

PubMed Disclaimer

Comment in

  • Vitamins for glaucoma.
    Galanopoulos A, Smith JR. Galanopoulos A, et al. Clin Exp Ophthalmol. 2020 Sep;48(7):877-878. doi: 10.1111/ceo.13849. Epub 2020 Sep 10. Clin Exp Ophthalmol. 2020. PMID: 32909296 No abstract available.

References

REFERENCES

    1. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121:2081-2090.
    1. Alqawlaq S, Flanagan JG, Sivak JM. All roads lead to glaucoma: induced retinal injury cascades contribute to a common neurodegenerative outcome. Exp Eye Res. 2019;183:88-97.
    1. Wiggs JL, Pasquale LR. Genetics of glaucoma. Hum Mol Genet. 2017;26:R21-R27.
    1. Bengtsson B, Leske MC, Hyman L, Heijl A. Fluctuation of intraocular pressure and glaucoma progression in the early manifest glaucoma trial. Ophthalmology. 2007;114:205-209.
    1. Niyadurupola N, Luu CD, Nguyen DQ, et al. Intraocular pressure lowering is associated with an increase in the photopic negative response (PhNR) amplitude in glaucoma and ocular hypertensive eyes. Invest Ophthalmol Vis Sci. 2013;54:1913-1919.

Publication types