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Updated: Oct 13, 2025
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Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential
Published on: May 25, 2020
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Nicotinamide and Pyruvate for Neuroenhancement in Open-Angle Glaucoma: A Phase 2 Randomized Clinical Trial
Carlos Gustavo De Moraes1, Simon W M John1,2,3, Pete A Williams4
1Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York.
JAMA Ophthalmology
|November 18, 2021
Summary
A combination of nicotinamide and pyruvate improved visual function in glaucoma patients, with more visual field test locations showing improvement in the treatment group. Further long-term studies are needed to confirm sustained benefits.
Area of Science:
- Ophthalmology
- Neuroscience
- Mitochondrial Biology
Background:
- Open-angle glaucoma can progress despite lowered intraocular pressure (IOP).
- Preclinical studies suggest mitochondrial enhancers may protect retinal ganglion cells, but clinical data is limited.
- Retinal ganglion cell survival is crucial for preventing glaucoma-induced vision loss.
Purpose of the Study:
- To evaluate if nicotinamide and pyruvate improve retinal ganglion cell function in human glaucoma patients.
- To measure changes in visual function using standard automated perimetry.
- To test the neuroprotective potential of metabolic enhancement in glaucoma.
Main Methods:
- Phase 2, randomized, double-blind, placebo-controlled trial.
- 42 patients with open-angle glaucoma and moderate visual field loss were randomized.
- Intervention: Oral nicotinamide (1000-3000 mg) and pyruvate (1500-3000 mg) vs. placebo.
Main Results:
- 32 participants completed the study; 21 received intervention, 11 received placebo.
- Significantly more visual field test locations improved in the nicotinamide/pyruvate group (15) vs. placebo (7) (P=.005).
- Treatment showed improvement in pattern standard deviation (PSD) but not mean deviation (MD) or visual field index (VFI).
Conclusions:
- Nicotinamide and pyruvate combination demonstrated short-term visual function improvement in glaucoma.
- Results support prior research on metabolic agents for glaucoma neuroprotection.
- Long-term studies are necessary to determine if this combination can slow glaucoma progression.
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