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Nicotinamide/B3 gets surprisingly strong human glaucoma evidence · Glaucoma, Vision & Longevity: Supplements & Science

• 0:00
  SPEAKER_00: Nicotinamide B3 gets surprisingly strong human glaucoma evidence.
• 0:04
  SPEAKER_00: What the 2026 studies show about vitamin B3, nicotinamide, glaucoma prevention, neuroprotection, dosage, and safety introduction.
• 0:13
  SPEAKER_00: As of August 13, 2026, the evidence linking nicotinamide, a form of vitamin B3, with glaucoma protection has become substantially more persuasive, but it still has not crossed the threshold required to change routine treatment.
• 0:28
  SPEAKER_00: Two new human studies are driving the renewed interest.
• 0:31
  SPEAKER_00: A July 9, 2026, JAMA ophthalmology cohort study found that patients with ocular hypertension who had documented systemic nicotinamide exposure were much less likely to receive a later diagnosis of primary open angle glaucoma.
• 0:47
  SPEAKER_00: An August 2026, American Journal of Ophthalmology analysis of the Rotterdam study found that higher dietary intake of niacin, the broader vitamin B3 category, and vitamin B12 was associated with a lower risk of developing open angle glaucoma.
• 1:03
  SPEAKER_00: These findings reinforce earlier randomized trials showing that nicotinamide may improve certain measures of retinal function in people who already have glaucoma.
• 1:13
  SPEAKER_00: They also fit a biologically plausible theory.
• 1:16
  SPEAKER_00: Aging, elevated eye pressure, and oxidative stress may deplete nicotinamine dinucleotide, or NAD plus, leaving retinal ganglion cells less able to produce energy and survive stress.
• 1:28
  SPEAKER_00: However, the most dramatic prevention result is observational, not randomized.
• 1:33
  SPEAKER_00: High dose nicotinamide also carries a real, although probably uncommon, risk of liver injury.
• 1:39
  SPEAKER_00: The evidence is promising enough to justify large clinical trials, but not yet strong enough to replace pressure-lowering treatment or support unsupervised high-dose supplementation.
• 1:50
  SPEAKER_00: The central new finding lower glaucoma conversion in ocular hypertension, what the JAMA ophthalmology study examined.
• 1:58
  SPEAKER_00: The study used de-identified electronic health record data from 67 United States healthcare organizations covering March 2006 through March 2026.
• 2:08
  SPEAKER_00: Researchers identified people with ocular hypertension but no previous open-angle glaucoma, laser treatment, or glaucoma eyedrop therapy.
• 2:17
  SPEAKER_00: The analysis compared 1,460 patients with documented systemic nicotinamide exposure, 1,460 propensity-matched control patients with no recorded use of nicotinamide or niacin.
• 2:31
  SPEAKER_00: The groups were followed for an average of 3.7 years.
• 2:34
  SPEAKER_00: The study was published online on July 9, 2026.
• 2:38
  SPEAKER_00: Primary open angle glaucoma diagnosis.
• 2:41
  SPEAKER_00: A subsequent diagnosis of primary open angle glaucoma occurred in.
• 2:44
  SPEAKER_00: For the full table, please open this article on VisualFieldTest.com.
• 2:48
  SPEAKER_00: The reported hazard ratio of 0.34 corresponds to approximately a 66% lower hazard of diagnosis during follow-up.
• 2:56
  SPEAKER_00: The absolute difference was 5.5 percentage points with a 95% confidence interval of 3.8 to 7.3 percentage points.
• 3:05
  SPEAKER_00: If the association were causal, a simple calculation would suggest that roughly 18 similar ocular hypertension patients would need to receive nicotinamide to prevent one additional diagnosis over approximately four years.
• 3:19
  SPEAKER_00: That number was not reported by the investigators and should not be interpreted as a treatment recommendation.
• 3:26
  SPEAKER_00: Fewer glaucoma treatments and laser procedures.
• 3:29
  SPEAKER_00: The study also found lower rates of treatment escalation.
• 3:33
  SPEAKER_00: Topical eye pressure lowering treatment, 13.6% with nicotinamide versus 21.2% in controls, hazard ratio, hazard ratio.57, laser trabeculoplasty 0.8% with nicotinamide versus 1.9% in controls, hazard ratio 0.38.
• 3:51
  SPEAKER_00: These findings suggest that nicotemede exposure was associated not only with fewer glaucoma diagnoses, but also with fewer downstream treatment decisions.
• 3:59
  SPEAKER_00: However, medication initiation and laser treatment are influenced by clinician judgment, follow-up patterns, coding, and patient preferences.
• 4:07
  SPEAKER_00: They are useful supporting outcomes, but they are not direct measurements of retinal ganglion cell survival.
• 4:13
  SPEAKER_00: Is the apparent effect unusually large?
• 4:15
  SPEAKER_00: Numerically, yes.
• 4:17
  SPEAKER_00: The size of the association is striking because it resembles the benefit of the best established prevention strategy for ocular hypertension, lowering intraocular pressure.
• 4:27
  SPEAKER_00: In the randomized ocular hypertension treatment study, five-year primary open-angle glaucoma incidence was 4.4% in patients assigned to pressure-lowering eye drops, 9.5% in patients assigned to observation.
• 4:40
  SPEAKER_00: That corresponded to a hazard ratio of approximately 0.40 and an absolute risk reduction of 5.1 percentage points.
• 4:47
  SPEAKER_00: The nicotinamide cohort reported 3.5% versus 9.0%, hazard ratio 0.34, absolute risk reduction 5.5% points.
• 4:57
  SPEAKER_00: Therefore, the observed nicotinamide association was at least as large numerically as the ocular hypertension treatment study result.
• 5:05
  SPEAKER_00: But the comparison is not proof that nicotinamide works as well as eye pressure lowering medication.
• 5:11
  SPEAKER_00: The studies differed in several important ways.
• 5:14
  SPEAKER_00: The ocular hypertension treatment study was randomized.
• 5:17
  SPEAKER_00: The nicotinamide study was observational.
• 5:20
  SPEAKER_00: The follow-up periods were different.
• 5:22
  SPEAKER_00: The participants may have had different levels of baseline risk.
• 5:26
  SPEAKER_00: The glaucoma outcomes were identified differently.
• 5:29
  SPEAKER_00: The nicotinamide study did not provide the same detailed, standardized measurements of eye pressure, corneal thickness, optic nerve appearance, and visual fields.
• 5:40
  SPEAKER_00: The correct interpretation is that the magnitude deserves urgent randomized testing, not that nicotinamide has already matched established treatment.
• 5:49
  SPEAKER_00: Why the JAMA study cannot establish causation.
• 5:52
  SPEAKER_00: Propensity matching can make groups look similar using recorded information, but it cannot reproduce randomization.
• 5:58
  SPEAKER_00: Several explanations other than a direct protective effect remain possible.
• 6:03
  SPEAKER_00: Exposure was documented, not directly measured.
• 6:06
  SPEAKER_00: The study evaluated documented systemic nicotinamide exposure.
• 6:10
  SPEAKER_00: Electronic records may not show the actual dose, the product formulation, how long the patient took it, whether the patient took it consistently, whether the product was prescribed, purchased over the counter, or obtained elsewhere.
• 6:24
  SPEAKER_00: A patient with a documented nicotinamide prescription may therefore differ considerably from a person taking a low dose supplement intermittently.
• 6:32
  SPEAKER_00: Residual confounding remains possible.
• 6:35
  SPEAKER_00: The records may not have fully captured important glaucoma risk factors, including family history, central corneal thickness, detailed baseline eye pressure, optic nerve structure, visual field status, genetic susceptibility, smoking, exercise, and dietary patterns, health literacy and access to specialist care.
• 6:55
  SPEAKER_00: Even after statistical adjustment, unmeasured differences can remain.
• 6:59
  SPEAKER_00: Healthy user bias is a serious possibility.
• 7:02
  SPEAKER_00: People who take supplements may also be more likely to attend preventive medical visits, follow eye care recommendations, exercise and eat a healthier diet, avoid smoking, seek care earlier, have better access to specialists.
• 7:16
  SPEAKER_00: Any of these factors could reduce the likelihood of glaucoma diagnosis or treatment escalation independently of nicotinamide.
• 7:24
  SPEAKER_00: Diagnosis and treatment are not identical to disease biology.
• 7:28
  SPEAKER_00: A lower rate of glaucoma coding could reflect a lower rate of disease, but it could also reflect differences in follow-up frequency, provider documentation, testing intensity, access to glaucoma specialists, thresholds for labeling ocular hypertension as glaucoma.
• 7:46
  SPEAKER_00: Likewise, fewer prescriptions or laser procedures could reflect clinician preference rather than less retinal damage.
• 7:52
  SPEAKER_00: The study did not prove a dose-response relationship.
• 7:55
  SPEAKER_00: A strong causal argument would be strengthened if higher doses, longer exposure, or higher blood nicotinamide levels were associated with progressively greater protection.
• 8:05
  SPEAKER_00: The available cohort result does not establish that relationship.
• 8:09
  SPEAKER_00: The study did not prove an intraocular pressure-independent effect.
• 8:13
  SPEAKER_00: The study did not establish whether nicotinamide users had lower eye pressure over time.
• 8:19
  SPEAKER_00: It is therefore impossible to determine whether the association reflects direct retinal neuroprotection, lower eye pressure, better treatment adherence, healthier behavior, or a combination of these factors.
• 8:33
  SPEAKER_00: These limitations are especially important because the apparent benefit was large.
• 8:37
  SPEAKER_00: Large effects from observational studies are valuable signals, but they are also particularly vulnerable to bias.
• 8:44
  SPEAKER_00: What the August 2026 Rotterdam study adds, the Rotterdam study provides a different kind of evidence.
• 8:50
  SPEAKER_00: Rather than examining high-dose supplements, investigators assessed usual dietary intake of several B vitamins in people initially free of open angle glaucoma.
• 9:00
  SPEAKER_00: The analysis included 6,742 participants, mean age 62.4 years, 58.2% women, 162 new cases of open angle glaucoma.
• 9:11
  SPEAKER_00: The analysis adjusted for at least age, sex, total calorie intake, diet quality, and follow-up time, niacin, or dietary vitamin B3.
• 9:20
  SPEAKER_00: Higher dietary niacin intake was associated with lower incident open angle glaucoma.
• 9:25
  SPEAKER_00: Odds ratio per additional milligram per day, 0.94.
• 9:29
  SPEAKER_00: Highest intake group, approximately 23.27 mg per day.
• 9:33
  SPEAKER_00: Lowest intake group, approximately 9.98 mg per day.
• 9:37
  SPEAKER_00: Highest versus lowest intake groups, odds ratio 0.43.
• 9:41
  SPEAKER_00: Trend across groups, P equals 0.02.
• 9:45
  SPEAKER_00: This is consistent with a potentially protective role for vitamin B3 related nutrition.
• 9:50
  SPEAKER_00: However, dietary niacin is not the same intervention as taking 1 to 3 grams of purified nicotinamide daily.
• 9:57
  SPEAKER_00: Food-based measures generally combine different sources and forms of vitamin B3 and are also strongly connected to overall dietary patterns.
• 10:05
  SPEAKER_00: Vitamin B12.
• 10:06
  SPEAKER_00: Vitamin B12 showed a similarly strong association.
• 10:10
  SPEAKER_00: Odds ratio per additional microgram per day.90.
• 10:14
  SPEAKER_00: Highest intake group, approximately 10.47 micrograms per day.
• 10:18
  SPEAKER_00: Lowest intake group, approximately 0.19 micrograms per day.
• 10:22
  SPEAKER_00: Highest versus lowest intake groups, odds ratio 0.25, trend across groups, P.01.
• 10:29
  SPEAKER_00: The B12 finding is biologically interesting because B12 participates in homocysteine metabolism.
• 10:35
  SPEAKER_00: Elevated homocysteine has been linked with vascular and neural injury, although the Rotterdam study cannot establish that homocysteine was the mechanism.
• 10:44
  SPEAKER_00: Intraocular pressure, retinal nerve fiber layer, and ganglion cells.
• 10:49
  SPEAKER_00: Higher niacin and B12 intake were both associated with a trend toward lower intraocular pressure.
• 10:55
  SPEAKER_00: Niacin P equals 0.04, vitamin B12 P equals 0.03.
• 11:00
  SPEAKER_00: Vitamin B12 intake was also associated with a thicker ganglion cell layer with a reported beta coefficient of 0.01 and a trend p-value of 0.002.
• 11:11
  SPEAKER_00: The positive structural signal was found for the ganglion cell layer rather than the retinal nerve fiber layer.
• 11:17
  SPEAKER_00: No comparable positive retinal nerve fiber layer association was reported.
• 11:22
  SPEAKER_00: These findings are compatible with both pressure-related and pressure-independent explanations.
• 11:27
  SPEAKER_00: They do not show that taking a B12 supplement or high-dose nicotinamide will preserve the optic nerve.
• 11:34
  SPEAKER_00: What earlier randomized human trials showed.
• 11:37
  SPEAKER_00: The 2026 observational studies did not arise in isolation.
• 11:41
  SPEAKER_00: They build on several small randomized trials.
• 11:44
  SPEAKER_00: Nicotinamide Alone, the 2020 Australian crossover trial.
• 11:49
  SPEAKER_00: The trial by Hui and colleagues enrolled 57 people with treated glaucoma.
• 11:54
  SPEAKER_00: Participants received nicotinamide at 1.5 grams daily for six weeks, then 3.0 grams daily for six weeks.
• 12:02
  SPEAKER_00: A placebo treatment during the other study period.
• 12:05
  SPEAKER_00: The main outcome was the photopic negative response, an electroretinographic measure that reflects inner retinal and retinal ganglion cell function.
• 12:13
  SPEAKER_00: After nicotinamide, photopic negative response amplitude improved by 14.8%.
• 12:19
  SPEAKER_00: The comparable placebo change was 5.2%.
• 12:22
  SPEAKER_00: The photopic negative response to B wave ratio improved by 12.6%.
• 12:27
  SPEAKER_00: The placebo change was 3.6%.
• 12:30
  SPEAKER_00: A visual field signal was also observed.
• 12:32
  SPEAKER_00: 27% of participants improved by at least 1 decibel on nicotinamide, while fewer deteriorated.
• 12:38
  SPEAKER_00: However, the overall difference in mean visual field deviation was not statistically significant.
• 12:44
  SPEAKER_00: Approximately plus 0.1 decibels p.63.
• 12:47
  SPEAKER_00: This study therefore showed a short-term improvement in retinal function, but it did not demonstrate long-term slowing of glaucoma.
• 12:54
  SPEAKER_00: Nicotinamide plus pyruvate, the 2022 phase 2 trial.
• 13:00
  SPEAKER_00: The Columbia University Phase 2 randomized trial included 42 people with treated moderate open-angle glaucoma, of whom 32 completed the study.
• 13:09
  SPEAKER_00: The intervention used escalating doses of nicotinamide, 1,000 to 3,000 mg daily, pyruvate, 1,500 to 3,000 mg daily.
• 13:20
  SPEAKER_00: After a median follow-up of approximately 2.2 months, the treatment group had a higher median number of improving visual field test locations, combination treatment, 15 locations, placebo, 7 locations, p.005.
• 13:35
  SPEAKER_00: Pattern standard deviation also suggested improvement, but there was no statistically significant difference in mean deviation or visual field index.
• 13:44
  SPEAKER_00: No serious adverse events occurred during this short trial.
• 13:48
  SPEAKER_00: The result supports short-term functional enhancement.
• 13:51
  SPEAKER_00: It does not establish that the combination prevents retinal ganglion cell death or slows visual field loss over years.
• 13:59
  SPEAKER_00: Nicotinamide alone in normal tension glaucoma, the 2026 Korean trial.
• 14:04
  SPEAKER_00: A 2026 randomized crossover trial enrolled 53 people with treated normal tension glaucoma.
• 14:11
  SPEAKER_00: Participants received nicotinamide at 1 gram daily for six weeks, then 2 grams daily for 6 weeks, placebo during the other treatment period.
• 14:20
  SPEAKER_00: After 12 weeks, nicotinamide significantly improved, photopic negative response peak to truff amplitude, B wave amplitude.
• 14:28
  SPEAKER_00: However, there were no significant differences in global visual field measures, including mean deviation, pattern standard deviation, or visual field index.
• 14:38
  SPEAKER_00: This is important because normal tension glaucoma occurs without markedly elevated untreated eye pressure.
• 14:45
  SPEAKER_00: The result supports the possibility of a metabolic effect that is not simply pressure lowering, but the trial was short and did not show a definitive visual field benefit.
• 14:55
  SPEAKER_00: Is nicotinamide more promising for prevention or established glaucoma?
• 15:00
  SPEAKER_00: At present, the evidence is stronger for preventing conversion from ocular hypertension to diagnosed glaucoma than for slowing established disease.
• 15:09
  SPEAKER_00: Prevention.
• 15:10
  SPEAKER_00: The prevention signal now comes from two large human cohorts.
• 15:14
  SPEAKER_00: The JAMA ophthalmology ocular hypertension study found a large association with lower primary open angle glaucoma diagnosis.
• 15:22
  SPEAKER_00: The Rotterdam study found that higher dietary niacin intake was associated with lower incident open angle glaucoma.
• 15:29
  SPEAKER_00: The limitation is that neither study randomized participants to nicotinamide.
• 15:34
  SPEAKER_00: Established glaucoma.
• 15:35
  SPEAKER_00: In people who already have glaucoma, randomized trials have shown better electroretinographic measures, more improving visual field points in one short trial, possible short-term visual field enhancement, no consistent improvement in global mean deviation, no evidence yet of long-term slowing of structural or functional progression.
• 15:57
  SPEAKER_00: The most reasonable conclusion is that nicotinamide may have both preventive and therintherapeutic potential, but the evidence is currently hypothesis-generating for established glaucoma and observational for prevention.
• 16:09
  SPEAKER_00: Does the effect appear independent of intraocular pressure reduction?
• 16:14
  SPEAKER_00: Possibly, but not conclusively.
• 16:16
  SPEAKER_00: Several observations support an intraocular pressure-independent mechanism.
• 16:21
  SPEAKER_00: The 2020 nicotinamide alone trial studied people already receiving pressure-lowering treatment.
• 16:27
  SPEAKER_00: The investigators reported no meaningful change in intraocular pressure with nicotinamide.
• 16:33
  SPEAKER_00: The normal tension glaucoma trial also studied patients whose untreated pressure was relatively low.
• 16:40
  SPEAKER_00: The proposed mechanism directly targets retinal metabolism rather than the drainage pathways that control eye pressure.
• 16:47
  SPEAKER_00: On the other hand, the Rotterdam study found that higher niacin and B12 intake were associated with lower intraocular pressure.
• 16:55
  SPEAKER_00: The JAMA cohort did not provide sufficient serial eye pressure data to determine whether pressure changed.
• 17:02
  SPEAKER_00: Fewer glaucoma prescriptions and laser treatments could reflect lower pressure rather than direct neuroprotection.
• 17:09
  SPEAKER_00: The best current description is potentially pressure-independent neuroprotection, not proven pressure-independent neuroprotection.
• 17:17
  SPEAKER_00: Nicotinamide should therefore be viewed as a possible adjunct to pressure lowering, not an alternative to it.
• 17:24
  SPEAKER_00: The proposed biological mechanism.
• 17:27
  SPEAKER_00: Retinal ganglion cells have high energy requirements.
• 17:30
  SPEAKER_00: Retinal ganglion cells must maintain long axons that travel from the eye to the brain.
• 17:35
  SPEAKER_00: This requires continuous production of adenosine triphosphate inside mitochondria.
• 17:40
  SPEAKER_00: These cells may be especially vulnerable when aging, eye pressure, reduced blood flow, or oxidative stress increase their metabolic demands.
• 17:49
  SPEAKER_00: Nicotinamide replenishes nicotinamide adenine dinucleotide.
• 17:52
  SPEAKER_00: Nicotinamide is used in the cellular salvage pathway to produce nicotinamide adenine dinucleotide, a central cofactor in mitochondrial energy production, oxidation reduction reactions, DNA repair, regulation of cellular stress responses, activity of NAD-dependent proteins such as sertuins.
• 18:12
  SPEAKER_00: Animal studies suggest that NAD levels fall with age and during experimental ocular hypertension.
• 18:17
  SPEAKER_00: Nicotinamide supplementation can restore NAD availability and make retinal ganglion cells more resistant to metabolic stress.
• 18:24
  SPEAKER_00: Energy failure may precede visible nerve loss.
• 18:27
  SPEAKER_00: The proposed sequence is aging or elevated eye pressure stresses mitochondria.
• 18:32
  SPEAKER_00: NAD availability falls, energy production becomes less efficient, oxidative stress and mitochondrial damage increase.
• 18:40
  SPEAKER_00: Retinal ganglion cells lose function.
• 18:42
  SPEAKER_00: Structural loss of axons and visual field damage follow.
• 18:46
  SPEAKER_00: If this sequence is correct, restoring NAD early might be more effective before irreversible cell loss has occurred.
• 18:54
  SPEAKER_00: Pyruvate may support glycolysis and antioxidant defenses.
• 18:58
  SPEAKER_00: Pyruvate is not vitamin B3, it is a metabolic intermediate that may help support glycolysis and may also act as an antioxidant.
• 19:05
  SPEAKER_00: This is why some glaucoma trials combine pyruvate with nicotinamide.
• 19:10
  SPEAKER_00: The two compounds are intended to support different parts of retinal energy metabolism.
• 19:15
  SPEAKER_00: Human doses compared with normal dietary intake.
• 19:18
  SPEAKER_00: The doses studied in glaucoma trials are far above ordinary nutritional intake.
• 19:23
  SPEAKER_00: For the full table, please open this article on VisualFieldTest.com.
• 19:28
  SPEAKER_00: A 3,000 milligram nicotinamide dose is roughly 200 times the usual adult nutritional requirement.
• 19:35
  SPEAKER_00: It should not be thought of as ordinary vitamin replacement.
• 19:38
  SPEAKER_00: It is a pharmacologic dose being tested as a potential neuroprotective treatment.
• 19:44
  SPEAKER_00: Safety of long-term high-dose nicotinamide liver injury is the most important concern.
• 19:49
  SPEAKER_00: Nicotinamide is generally less likely than nicotinic acid to cause flushing, but high doses are not automatically harmless.
• 19:57
  SPEAKER_00: A serious case of probable drug-induced liver injury occurred during a glaucoma trial using 3 grams of nicotinamide daily.
• 20:05
  SPEAKER_00: The investigators reported the case because many patients were taking high-dose nicotinamide outside clinical trials without systematic laboratory monitoring.
• 20:14
  SPEAKER_00: The risk appears to be uncommon, but the available glaucoma trials are too small and too short to determine how often liver injury occurs during years of treatment.
• 20:24
  SPEAKER_00: Other possible dose-related effects.
• 20:26
  SPEAKER_00: Reported or suspected risks of high-dose nicotinamide include nausea, vomiting, and abdominal discomfort, diarrhea, abnormal liver enzymes, drug-induced liver injury, possible effects on blood glucose and insulin sensitivity, thrombocytopenia in some populations, easy bruising or increased bleeding tendency at higher supplemental doses.
• 20:49
  SPEAKER_00: The National Institutes of Health notes that nausea, vomiting, and signs of liver toxicity can occur with nicotinamide intakes around 3,000 mg daily.
• 20:59
  SPEAKER_00: Current professional safety advice The American Glaucoma Society and American Academy of Ophthalmology have stated that nicotinamide is not approved for glaucoma and that evidence is insufficient for routine use.
• 21:12
  SPEAKER_00: Their safety recommendations include: do not use high-dose nicotinamide outside a monitored clinical trial.
• 21:19
  SPEAKER_00: Patients with current or previous liver disease should not take it for glaucoma neuroprotection.
• 21:24
  SPEAKER_00: If lower doses are being considered outside a trial, involve the patient's primary care clinician and monitor liver function.
• 21:32
  SPEAKER_00: Do not substitute niacin for nicotinamide.
• 21:35
  SPEAKER_00: These recommendations remain appropriate despite the new observational evidence.
• 21:40
  SPEAKER_00: Nicotinamide is not the same as niacin, nicotinamide riboside, or nicotinamide mononucleotide.
• 21:47
  SPEAKER_00: The terminology is confusing because several related molecules are grouped under vitamin B3.
• 21:52
  SPEAKER_00: Nicotinamide, also called niacinamide.
• 21:56
  SPEAKER_00: This is the compound most directly studied in glaucoma neuroprotection trials.
• 22:00
  SPEAKER_00: It is a precursor to nicotinamide adenine dinucleotide.
• 22:04
  SPEAKER_00: It generally does not cause the flushing associated with nicotinic acid.
• 22:08
  SPEAKER_00: High doses can still cause gastrointestinal effects and liver injury.
• 22:13
  SPEAKER_00: The glaucoma evidence discussed in this article primarily concerns nicotinamide, niacin, or nicotinic acid.
• 22:20
  SPEAKER_00: This is a different molecule.
• 22:22
  SPEAKER_00: It can cause flushing, itching, and headache.
• 22:25
  SPEAKER_00: It has cholesterol-lowering effects at pharmacologic doses.
• 22:29
  SPEAKER_00: It has a well-established risk of liver toxicity, especially with some extended release preparations.
• 22:34
  SPEAKER_00: It should not be substituted for nicotinamide and glaucoma.
• 22:38
  SPEAKER_00: Nicotinamide riboside, nicotinamide ribicide is another NAD precursor.
• 22:43
  SPEAKER_00: It is chemically and metabolically distinct from nicotinamide.
• 22:46
  SPEAKER_00: A randomized glaucoma protocol has studied 300 mg daily for 24 months, but a long-term glaucoma benefit has not been established.
• 22:55
  SPEAKER_00: Nicotinamide mononucleotide, nicotinamide mononucleotide, is also an NAD precursor, but it is not the same as nicotinamide.
• 23:04
  SPEAKER_00: A short-term registered trial is comparing nicotinamide, nicotinamide ribicide, nicotinamide mononucleotide, and nicotinic acid in glaucoma patients.
• 23:13
  SPEAKER_00: But this study is designed mainly to compare short-term visual function and biochemical effects, not to prove long-term neuroprotection.
• 23:21
  SPEAKER_00: Current large glaucoma nicotinamide trials.
• 23:24
  SPEAKER_00: Several prospective randomized trials are now underway.
• 23:27
  SPEAKER_00: For the full table, please open this article on visualfieldtest.com.
• 23:32
  SPEAKER_00: The glaucoma nicotinamide trial includes both newly diagnosed, previously untreated patients and patients already receiving eye pressure lowering treatment.
• 23:41
  SPEAKER_00: The nicotinamide and glaucoma trial is a large phase 3 study specifically designed to evaluate whether nicotinamide slows visual field loss.
• 23:50
  SPEAKER_00: The Columbia University trial is testing a combination of nicotinamide and pyruvate.
• 23:56
  SPEAKER_00: Registry completion dates are estimates, not guaranteed publication dates.
• 24:01
  SPEAKER_00: Even if a trial finishes recruitment or follow-up in 2026 or 2027, peer-reviewed results may appear later.
• 24:08
  SPEAKER_00: Does the evidence justify changing clinical practice?
• 24:12
  SPEAKER_00: No, not yet.
• 24:13
  SPEAKER_00: The 2026 evidence is unusually encouraging because it now includes a large ocular hypertension cohort with a substantial reduction in glaucoma diagnosis, a large prospective dietary cohort with lower incident glaucoma associated with niacin intake, several randomized trials showing improved short-term retinal function, a coherent mitochondrial NID-related biological mechanism, multiple large phase 3 trials designed to measure long-term visual field progression.
• 24:43
  SPEAKER_00: But the remaining gaps are decisive.
• 24:45
  SPEAKER_00: The strongest prevention result is observational.
• 24:48
  SPEAKER_00: Dietary niacin is not the same as high-dose nicotinamide.
• 24:52
  SPEAKER_00: Existing randomized trials are small and short.
• 24:55
  SPEAKER_00: Global visual field improvement has not been consistently demonstrated.
• 25:00
  SPEAKER_00: Long-term reduction in retinal nerve fiber layer loss has not yet been proven.
• 25:04
  SPEAKER_00: High-dose nicotinamide may rarely cause serious liver injury.
• 25:08
  SPEAKER_00: The effective dose, ideal patient group, and long-term risk-benefit balance remain unknown.
• 25:14
  SPEAKER_00: For now, patients should continue proven glaucoma care, especially individualized intraocular pressure reduction and regular monitoring of the optic nerve, retinal nerve fiber layer, and visual field.
• 25:26
  SPEAKER_00: Nicotinamide should not replace eye drops, laser treatment, or surgery.
• 25:31
  SPEAKER_00: Conclusion.
• 25:32
  SPEAKER_00: Nicotinamide has moved from an intriguing laboratory theory to one of the most credible experimental neuroprotective strategies in glaucoma.
• 25:40
  SPEAKER_00: The JAMA ophthalmology ocular hypertension cohort is the most important new finding.
• 25:45
  SPEAKER_00: Documented nicotinamide exposure was associated with a reduction in primary open-angle glaucoma diagnosis from 9.0 to 3.5%, with fewer eyedrop prescriptions and laser procedures.
• 25:59
  SPEAKER_00: The magnitude is comparable to the benefit of pressure-lowering medication in the randomized ocular hypertension treatment study.
• 26:06
  SPEAKER_00: The Rotterdam study strengthens the broader nutritional signal, linking higher dietary niacin and vitamin B12 intake with lower incident open-angle glaucoma, lower eye pressure, and, for vitamin B12, a thicker ganglion cell layer.
• 26:21
  SPEAKER_00: Nevertheless, these results do not prove that taking high-dose nicotinamide prevents glaucoma.
• 26:27
  SPEAKER_00: The most important unanswered question is whether a properly dosed, carefully monitored nicotinamide regimen can slow visual field and retinal nerve fiber layer loss over several years without unacceptable liver or metabolic risks.
• 26:42
  SPEAKER_00: That answer should come from the large randomized trials now underway, not from self treatment with over-the-counter supplements.
• 26:49
  SPEAKER_00: All links to sources are available in the text version of this article.
• 26:53
  SPEAKER_00: You can find the full article at VisualFieldTest.com.
• 26:57
  SPEAKER_00: Thanks for listening.
• 26:59
  SPEAKER_00: To check your visual field, click the link at the bottom of this article or visit visualfieldtest.com.