John’s work inspired scientists at the Center for Eye Research Australia to take it a step further. The results of the first clinical trial of vitamin B3 for glaucoma showed “significant improvement” in eye nerve cell function in 57 participants. The patients took 3,000 mg of nicotinamide each day for 12 weeks, along with regular eye pressure-lowering medication. The researchers say a larger study is needed to determine whether or not B3 should be taken on an ongoing basis.

A separate clinical trial of B3 for treatment of glaucoma is currently underway in the U.K. The four-year endeavor will involve roughly 500 Glaucon a recent interview, Simon John, Ph.D., the Columbia University Irving Medical Center’s Robert L. Burch III Professor of Ophthalmic Sciences, discussed his encouraging research concerning the use of vitamin B3 (niacin) and pyruvate supplements for glaucoma prevention.*

Thinking differently about glaucoma

Simon John’s predecessor, Columbia ophthalmology investigator Laszlo Bito, Ph.D., was instrumental in the research leading to the approval of the popular glaucoma medication latanoprost in 1996. While millions have benefitted from the eye pressure-lowering drug, John recognized that many people still develop the disease at normal eye pressure and saw a need for intervention.

John got the idea that vitamin B3 and pyruvate could potentially prevent glaucoma from his unique observations of mice with elevated eye pressure. In the disease’s early stages, John’s team noted dysfunction in retinal cell mitochondria, where energy is produced. They also noticed that as mice got older, their levels of nicotinamide adenine dinucleotide (NAD)—a derivative of niacin, that promotes mitochondrial health—declined.

John’s mentor, Nobel Prize-winner Oliver Smithies, advised experimenting with vitamin B3. The results were significant.

• Not only did B3 boost NAD, but “many fewer” mice with high eye pressure and high NAD developed glaucoma. The highest dose studied prevented glaucoma in 93% of eyes.
• B3 also stopped disease progression in older mice already showing signs of the disease.

John says the nutrient pyruvate (pie-ROO-vate), a molecule involved in energy metabolism in cell mitochondria, showed a similar effect. His research later showed that vitamin B3 and pyruvate worked even more effectively when used together.

Additionally, John and his team experimented with gene therapy using Nmnat1, a key enzyme in NAD production. While Nmnat1 did improve NAD levels and resulted in similar glaucoma benefits, it was not as effective as niacin.

How vitamin B3 works against glaucoma

Niacin’s derivatives are protective against substances that can damage and kill cells. NAD is a key player in energy metabolism, but levels in the eye decline as we age, which puts our eyes at risk for disease.

John’s research with mice demonstrated that adding an oral B3 supplement (a water-soluble vitamin):

• Boosted NAD,
• Reduced metabolic dysfunction,
• Protected ganglion cells, and
• Preserved vision.

More specifically, there was less:

• Degradation of the optic nerve,
• Thinning of the retinal nerve fiber layer, and
• Ganglion cell death.

Other supportive research

ma patients.

‘A very exciting time’

Recently, John and his team also completed research on 21 glaucoma patients with moderate vision loss and observed “significant” visual improvements over several months.

John initially encountered stiff resistance for his approach to glaucoma research using mice, but his findings have led to a fundamental change in how his colleagues view glaucoma. He says that, as we learn more about the disease, other molecules more powerful than niacin and pyruvate could be discovered. All in all, he concludes, “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