Among patients with high eye pressure, those who took vitamin B3 (nicotinamide) supplements were about two thirds less likely to be diagnosed with primary open-angle glaucoma (POAG) and needed fewer treatments, including pressure-lowering eye drops and laser procedures, than those who did not take the supplements.
METHODOLOGY
- Researchers analyzed electronic medical record data from March 2006 to March 2026 to assess whether patients with ocular hypertension who took nicotinamide were less likely to develop POAG and had a delayed need for eye drops or laser procedures to reduce intraocular pressure.
- A total of 2920 patients with ocular hypertension were included, of whom 1460 patients with at least one recorded instance of using nicotinamide (mean age, 54.4 years; 57.9% women) were compared with 1460 matched control individuals with no recorded history of using either nicotinamide or niacin (mean age, 54.9 years; 59.5% women).
- Patients with a prior diagnosis of open-angle glaucoma, a history of first-line glaucoma topical therapy, or a history of laser therapy were excluded.
- The primary outcome was the time to a POAG diagnosis, and secondary outcomes included the prescription of first-line topical glaucoma therapy and/or laser trabeculoplasty.
TAKEAWAY
- Over a mean follow-up of 3.7 years, 51 patients taking nicotinamide developed POAG compared with 132 not taking the supplement (3.5% vs 9.0%; hazard ratio [HR], 0.34; P < .001), representing a 66% relative reduction in the risk for POAG diagnosis.
- Topical intraocular pressure-lowering therapy was initiated in 198 patients (13.6%) in the nicotinamide group vs 309 patients (21.2%) in the control group (HR, 0.57; P < .001), representing a 43% relative reduction in the risk of initiating topical therapy.
- Laser trabeculoplasty was performed in 12 patients (0.8%) in the nicotinamide group vs 28 patients (1.9%) in the control group (HR, 0.38; P = .003), representing a 62% relative reduction in the risk of undergoing the procedure.
- In the analysis restricted to patients who received their first nicotinamide prescription after a diagnosis of ocular hypertension (947 matched pairs; mean follow-up, 4.2 years), nicotinamide remained associated with a reduced risk for POAG diagnosis (HR, 0.42; P < .001).
IN PRACTICE
“By potentially delaying POAG diagnosis and decreasing the rate of subsequent prescribed interventions, nicotinamide represents a potential adjunctive strategy complementary to standard therapy, warranting further prospective investigation,” the researchers reported.
“While the clinical significance and long-term benefit of nicotinamide in glaucoma remain to be established, this study adds to the growing body of laboratory, early human, and real-world evidence suggesting potential promise. The ophthalmic community now awaits the results of ongoing randomized clinical trials to determine whether nicotinamide will ultimately have a defined role in glaucoma management,” Simon K. Law, MD, PharmD, of the Stein Eye Institute at the University of California, Los Angeles, wrote in editorial accompanying the journal article.
SOURCE
The study was led by Jawad Muayad, MD, of Texas A&M University in Houston. It was published online on July 9 in JAMA Ophthalmology.
LIMITATIONS
Nicotinamide is sold over the counter and frequently not recorded by clinicians, so some use was likely missed. The records also did not show the exact dose, type of product, or how often people took it, and the best protective dose is still unknown. Those with documented nicotinamide use may have been more proactive about their health, which could contribute to better outcomes independent of the supplement itself. The study lacked detailed eye measurements like eye pressure, corneal thickness, or optic nerve findings.
DISCLOSURES
Some authors disclosed receiving consulting fees, research support, and speaking engagements with multiple organizations.
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