Since its approval in 1996, the glaucoma drug latanoprost has preserved the sight of millions as the standard treatment for lowering eye pressure and preventing glaucoma-related retinal damage and blindness. But the drug isn’t effective for everyone, and glaucoma researcher, Simon John, Ph.D., has been engaged in ongoing research to change that.

Up to the Challenge

Doctor John, a renowned glaucoma researcher, and Robert L. Burch III, professor of Ophthalmic Sciences at Columbia’s Vagelos College of Physicians and Surgeons, explain that even at normal eye pressure, the retina can still deteriorate, leaving many vulnerable to vision loss. 

Why Vitamin B3 and Pyruvate for Glaucoma?

In John’s preliminary research, John observed mice with high intraocular pressure that didn’t yet have glaucoma. This presented a unique opportunity to observe the changes in the eye before the disease.

• Dysfunction of retinal cell mitochondria was observed, suggesting that mitochondria could play a key role in glaucoma.
• Further, levels of NAD (a molecule that supports mitochondrial health) were seen to decline as the mice aged.

At the urging of his Nobel Prize-winning mentor, Oliver Smithies, John treated the mice with vitamin B3 (niacin) supplementation since the vitamin is a major building block of NAD.

• Vitamin B3 boosted NAD levels, as did pyruvate when tested later. (Pyruvate is an important energy compound made by the body and found in certain foods and in pill form.)
• Much fewer mice with elevated NAD and elevated eye pressure developed glaucoma.

Vitamin B3 and pyruvate were eventually found to be more effective at preventing glaucoma in mice when used in combination.

Testing Vitamin B3 and Pyruvate in People

On the heels of last year’s first clinical trial of vitamin B3 and pyruvate in people, a Phase 2 study has just been completed evaluating the nutrients’ effectiveness against glaucoma, again showing promising results.

In the Phase 2 randomized controlled trial:

• Thirty-two people with open-angle glaucoma and moderate visual field loss in at least one eye completed the study.
• The average age was roughly 65 years old, and 66% (21 participants) were female.
• Twenty-one people were randomly chosen for treatment with oral nicotinamide (a form of vitamin B3) and pyruvate, and the remaining 11 were given a placebo.
• Treatment consisted of an increasing dose of nicotinamide (1,000-3,000 mg) and pyruvate (1,500-3,000 mg).

John and his team found that treatment of glaucoma with vitamin B3 and pyruvate was safe, and visual field improvement was greater in the treatment group versus placebo after several months.

John says other researchers are getting positive findings with vitamin B3, with an Australian group testing B3 alone and finding improved inner retinal function. 

Larger studies are needed to confirm his team’s results and their longevity. But John says their work is just beginning and that they may discover other compounds even more effective than vitamin B3 and pyruvate as they learn more about glaucoma.

“It’s a very exciting time in biomedical research.”

*Columbia University Irving Medical Center. (2022, January 31). Can Nutrient Supplements Prevent Glaucoma? https://www.cuimc.columbia.edu/news/can-nutrient-supplements-prevent-glaucoma