Over 80 million people worldwide suffer from glaucoma, experiencing a progressive loss of vision that can lead to total blindness. This neurodegenerative disease of the optic nerve has no cure, and once a person starts losing their vision, it cannot be restored. At best, current treatments such as laser therapy, surgery, and eye drops slow the progressive decline by reducing intraocular pressure – but they don’t always work. What if a simple vitamin could provide an effective therapy for this debilitating condition?
Exciting studies in both animals and humans have recently shown that nicotinamide (a form of vitamin B3 that’s also known as niacinamide) could be a safe, affordable option for improving eye function in those with glaucoma. So, let’s take a closer look at glaucoma and why nicotinamide shows such promise.
What is glaucoma?
Glaucoma is a progressive condition that irreversibly damages eyesight, leading to very poor vision or even complete blindness. The underlying cause of the disease is a build-up of fluid pressure in the eye that damages the optic nerve, the nerve fiber that transmits information from the eye to the brain. Glaucoma can also occur when eye pressure is normal, although this is less common.
Symptoms usually appear only after there’s been some damage and vision has become impaired.
Who is at risk for glaucoma?
There are several risk factors to watch out for:
- a family history of glaucoma;
- long-term use of steroids or nasal sprays;
- eye trauma or injury;
- severe nearsightedness;
- have diabetes; and
- high blood pressure.
The risk is also higher for people of African or Asian descent and anyone over the age of 50.
Blurred vision, blind spots, and loss of peripheral vision are all warning signs. So is struggling to adjust to low light. You might also feel pressure or eye pain or experience headaches.
What causes glaucoma?
There are approximately 1.2 million retinal ganglion cells (RGCs) in the human eye.
RGCs are a type of neuron. They receive visual information in the form of electrochemical signals from photoreceptors (called rods and cones) within the retina. The RGCs send these signals from the eye (via the optic nerve) to the brain, which converts them to a visual form.
RCGs need a great deal of energy to function optimally, and they depend on mitochondria to create it. If the mitochondria don’t produce enough, the RGCs may become damaged or even die. They cannot be regenerated.
How does nicotinamide help with glaucoma?
Researchers have discovered that if they can rescue the damaged RGCs before it’s too late, they have a chance of slowing or even stopping the progression of the disease. That’s where nicotinamide comes in.
The mitochondria’s ability to produce sufficient energy is closely related to the availability of NAD+ (nicotinamide adenine dinucleotide). NAD+ is one of the key molecules involved in creating cellular energy. It is also involved in protecting neurons and reducing inflammation and free radical damage. It is essential for mitochondrial health.
The body produces NAD+ via tryptophan, niacin (another form of B3) and nicotinamide. Researchers have discovered that the retina and RGC’s prefer the nicotinamide salvage pathway; they can use this energy directly. Nicotinamide has demonstrated greater potential for treating glaucoma than other molecules that improve mitochondrial function.
What have the trials shown so far?
Recent trials have shown that NAD+ levels within the eye can be increased by orally administering nicotinamide, which improves visual function in existing glaucoma patients.
Williams et al. showed that nicotinamide was effective in decreasing glaucoma in animal models.
Tribble et al. found that nicotinamide protected the RGCs from metabolic damage in animal studies and could serve as a neuroprotective agent against glaucoma.
Hui et al. conducted a small clinical trial on 57 patients with glaucoma. Patients took a daily dose of 1.5 grams for six weeks; the dose was then increased to 3 grams. After 12 weeks, both nerve cell function and the results of visual field tests improved compared to placebo.
Since glaucoma is a chronic long-term condition, there is currently a larger two-year collaborative clinical study being conducted in several countries. Researchers want to determine whether long-term use of nicotinamide can slow down vision loss and whether it has any other benefits for glaucoma patients.
What does this mean for people with glaucoma?
Doctors used to believe that reducing intraocular pressure was the only way to help patients. Now, there’s sufficient evidence that therapeutic doses of nicotinamide can also improve vision.
The question remains, however, whether the current clinical trial that was completed in 2026 will confirm the exciting results that researchers have found thus far. If so, nicotinamide may become a standard of care (along with pressure reduction) in the treatment of glaucoma.
Nicotinamide is widely available and has been shown to be both affordable and safe at the high therapeutic doses required to treat this condition. That in itself is something to be excited about.
Read more about how to ensure healthy vision from birth to your older years.
Read more extensively about vision loss as you age. From birth to death in this fascinating summary of the Huberman Podcast with Dr. Jeffrey Goldberg. A leading authority on vision health:
Main image credit: The main image was derived from this important resource that explains the link between diabetes and Glaucoma: Diabetes UK
The Vitamin B3 in Glaucoma Study (VBIGS): A 2-year Multi-centre, Double-masked, Randomised, Placebo-controlled Trial of Nicotinamide (Vitamin B3) Supplementation in Glaucoma https://www.cera.org.au/trials/the-vitamin-b3-in-glaucoma-study-vbigs-trial/
Bhartiya S. Niacinamide and Neuroprotection: The Glaucoma Holy Grail. J Curr Glaucoma Pract. 2022 Sep-Dec;16(3):141-143. doi: 10.5005/jp-journals-10078-1390. PMID: 36793265; PMCID: PMC9905873.
Williams PA, Harder JM, Foxworth NE, Cochran KE, Philip VM, Porciatti V, Smithies O, John SW. Vitamin B3 modulates mitochondrial vulnerability and prevents glaucoma in aged mice. Science. 2017 Feb 17;355(6326):756-760. doi: 10.1126/science.aal0092. PMID: 28209901; PMCID: PMC5408298.
Tribble JR, Otmani A, Sun S, Ellis SA, Cimaglia G, Vohra R, Jöe M, Lardner E, Venkataraman AP, Domínguez-Vicent A, Kokkali E, Rho S, Jóhannesson G, Burgess RW, Fuerst PG, Brautaset R, Kolko M, Morgan JE, Crowston JG, Votruba M, Williams PA. Nicotinamide provides neuroprotection in glaucoma by protecting against mitochondrial and metabolic dysfunction. Redox Biol. 2021 Jul;43:101988. doi: 10.1016/j.redox.2021.101988. Epub 2021 Apr 24. PMID: 33932867; PMCID: PMC8103000.
Hui F, Tang J, Williams PA, McGuinness MB, Hadoux X, Casson RJ, Coote M, Trounce IA, Martin KR, van Wijngaarden P, Crowston JG. Improvement in inner retinal function in glaucoma with nicotinamide (vitamin B3) supplementation: A crossover randomized clinical trial. Clin Exp Ophthalmol. 2020 Sep;48(7):903-914. doi: 10.1111/ceo.13818. Epub 2020 Jul 28. PMID: 32721104.
Glaucoma: Facts & Figures – https://www.brightfocus.org/glaucoma/article/glaucoma-facts-figures#