Citicoline is a naturally occurring compound in the brain and a building block of cell membranes. There is clinical evidence that citicoline has beneficial effects in neurodegenerative diseases, such as Parkinson’s disease, senile and vascular dementia, and strokes. Research on the effect of citicoline on vision shows that citicoline improves visual acuity, visual evoked responses, and contrast sensitivity.

A 2020 study, published in the Journal of Glaucoma, explored whether adding citicoline eye drop therapy to traditional intraocular pressure-lowering (IOP) treatment could slow glaucoma progression in patients with increasing neurodegeneration and an IOP of 18 mm Hg or less.*

What they did

The study was a randomized, placebo-controlled, double-masked trial conducted at three university eye clinics in Milan, Rome, and Genoa, Italy, between summer 2015 and spring 2019. 

Eighty patients who were at least 18 years old and had mild to moderate open-angle glaucoma (OAG) began the study, but only 78 completed it. 

Participants received the best possible treatment options to control their IOP and maintain visual function, along with either citicoline eye drops or a placebo three times daily for three years. There were four follow-up visits per year, during which all participants received a complete ophthalmologic assessment and a visual field (VF) test. There were two “rapid progressors” at baseline, one in each group. In both cases, treatment regimens were changed throughout the study.

Study outcomes included:

• Differences in rates of visual field progression between the two groups
• Changes in loss of retinal nerve fiber layer (RNFL) thickness 
• Safety and tolerability of citicoline eye drops 

What they found

The trial yielded mixed results:

• The citicoline group lost an average of 1.86 micrometers of RNFL vs. 2.99 micrometers in the placebo group.
• At months 27 and 36, IOP was significantly lower in the placebo group than in the citicoline group.
• During the study, 30/78 (38%) of the patients progressed. 
• Compared with the pretrial rates, both patients receiving citicoline and placebo showed an improvement in the progression rates. 
• Three cases stabilized (two in the citicoline group and one in the placebo group).
• In both “rapid progressor” cases, rates of change improved.

What it means

The results of the trial showed that both groups showed some improvement in terms of progression rate. The citicoline group did show significant improvement in specific areas, such as electrophysiological function; however, functional improvement regressed to baseline values after the citicoline drops were stopped in this group, as well, suggesting that the benefits may be temporary. No information regarding long-term VF changes was available. 

While the findings are inconclusive, they provide a basis for further research.

*Rossetti, L.l., Lester, M., Tranchina, L., Ottobelli, L., et al. (2020, July). Can Treatment With Citicoline Eyedrops Reduce Progression in Glaucoma? The Results of a Randomized Placebo-controlled Clinical Trial. Journal of Glaucoma. https://journals.lww.com/glaucomajournal/fulltext/2020/07000/can_treatment_with_citicoline_eyedrops_reduce.3.aspx