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Updated: Aug 5, 2026
Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential
Published on: May 25, 2020
A Topographical Analysis of Visual Field Improvement in a Phase 2 Randomized Trial of Nicotinamide and Pyruvate for
C Gustavo De Moraes1, Aakriti G Shukla1, George A Cioffi1
1Department of Ophthalmology, Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, United States.
Purpose:
The purpose of this study was to characterize topographical visual field (VF) improvement using pointwise total deviation (TD) slopes referenced to baseline severity, and to evaluate structure-function and cognitive associations in eyes receiving nicotinamide and pyruvate (NAM + PYR) treatment versus placebo.
Methods:
This post hoc analysis used study-eye data from a phase 2 randomized trial of nicotinamide (3 g/day) plus pyruvate (3 g/day) versus placebo in open-angle glaucoma, with four baseline and four post-baseline VF visits. A location was improving if its Huber robust pointwise TD slope ranked in the upper decile (≥90th percentile) of the pooled slope distribution within its baseline-severity stratum. Bayesian hierarchical models assessed treatment effects, incorporating optical coherence tomography retinal nerve fiber layer (RNFL) slopes as structural priors; Montreal Cognitive Assessment (MoCA) scores tested for cognitive confounding.
Results:
Thirty-two study eyes (21 receiving NAM + PYR, and 11 placebo) were analyzed. NAM + PYR treated eyes showed increased identification of improving locations versus placebo (Cochran-Mantel-Haenszel pooled odds ratio (OR) = 3.73, 95% confidence interval (CI) = 2.36-5.89, P < 0.001); a TD-difference sensitivity analysis was concordant (OR = 5.08, 95% CI = 1.22-21.17, P = 0.021). Improvement clustered along arcuate pathways and within moderate-to-deep baseline damage. The Bayesian model estimated a 98.4% posterior probability that NAM + PYR treatment increased improving locations; RNFL priors corroborated modestly but did not materially refine inference. No association was found with MoCA scores.
Conclusions:
Topographical, slope-based endpoints reveal localized arcuate VF improvement with nicotinamide and pyruvate that is missed by global indices and not explained by cognitive change. Bayesian modeling suits small early-phase neuroprotection trials, although structural priors added little over this short follow-up.