• Nutritional Supplements May Promote Neurorecovery in Glaucoma

    By Jean Shaw
    Selected and Reviewed by Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, January 2022

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    De Moraes et al. investigated whether the combination of nicotinamide (a form of vitamin B3) and pyruvate could improve retinal ganglion cell function in glaucoma patients with moderate functional loss. They found that it yielded short-term improvement in visual field (VF) sensitivity.

    For this phase 2 study, 42 participants with mild or moderate glaucoma and moderate VF loss in at least one eye were randomized to receive either placebo or oral nicotinamide plus pyruvate. All patients were taking IOP-lowering medications. To minimize learning effects of VF testing, the patients were required to have undergone at least three VF exams in the three years before enrollment.

    Thirty-two of the participants completed the study and were included in the final analysis. The primary outcome measure was the number of VF test locations improving beyond normal variability in the study eye. Secondary endpoints included pattern standard deviation and VF index.

    Participants in the treatment group (n = 21) took ascending doses of a combined supplement of nicotinamide (1,000 to 3,000 mg/day) and pyruvate (1,500 to 3,000 mg/day) during the first three weeks. VF tests were performed at baseline and at the end of weeks 2 and 3. The supplement was then discontinued, and a final VF test was taken at the end-of-study visit. Median time of follow-up was 2.2 months (range, 2-2.4 months).

    The results showed that the number of improving test locations was higher in the treatment group than in the placebo group (median, 15 [6-25] vs. 7 [6-11]; p = .005). Logistic mixed-effects regression also revealed that eyes treated with the supplement were more likely to experience improving test locations (odds ratio [OR], 3.20; 95% confidence interval [CI], 1.25-8.16; p = .01).

    The rates of VF pattern standard deviation were higher in the treatment group (median, –.06 [–.03 to .06] dB per week, vs .02 [–.07 to 07] dB per week; 95% CI, .02 to .24; mixed-effects model p = .02). However, there was no difference between groups regarding rates of change of the VF mean deviation or the VF index. While no serious adverse events were reported during the study, 33% of those in the treatment group experienced mild gastrointestinal distress that improved with continued dosing. (Also see related commentary by Pradeep Y. Ramulu, MD, MHS, PhD, in the same issue.)

    The original article can be found here.