Detailed Description of The Effect of Oral Citicoline and Docosahexaenoic Acid on the Visual Field of Patients with Glaucoma.

Abstract

Purpose : A clinical trial performed by our group demonstrated that patients receiving oral citicoline and docosahexaenoic acid (DHA) showed a significant improvement in visual field indices compared to other treatment groups.¹ The aim of the present study was to describe in detail the effect of citicoline and DHA in the visual fields (VF) of glaucoma patients participating in that trial.

Methods : Prospective, randomized, controlled study. Glaucoma patients were randomized to one of four groups and treated for 3 months with vitamin C, DHA, citicoline or a combination of DHA and citicoline. The global results of the study have been published.¹ For the present study the functional changes observed in participants treated with the combination of DHA and citicoline were analyzed in detail. Changes in visual field indices and their slopes were evaluated. Number of cases with improvement, no change or worsening of Mean Defect (MD) and Visual Field Index (VFI) was compared during treatment period with Chi² Test. Pretreatment slopes and during treatment slopes of MD and VFI were compared with Paired t test. Fifteen patients continue follow up visits in our clinic after the study and underwent VF testing every 3-4 months. The evolution of VF after treatment was discontinued was assessed.

Results : Twenty patients were randomly assigned to receive DHA and citicoline for 3 months. Patients with MD improvement (>0.5 dB, N=14) during treatment were significantly more frequent (p<0.001) than those patients during pretreatment period (N=5). Patients with VFI improvement (>1.5 %, N=14) during treatment were significantly more frequent (p=0.005) than those patients during pretreatment period (N=4) or those who showed worsening > 0,5 dB (N=4). MD slopes improved in 16 patients (80%, p<0.001) from pretreatment period to treatment period. VFI slopes improved in 15 patients (75%, p=0.03) from pretreatment period to treatment period. VF indexes and indexes’ slopes returned to pretreatment values in 3 to 6 months after discontinuing citicoline and DHA.

Conclusions : VF indices' absolute values and their slopes significantly improved globally and, specifically in approximately 70% of treated patients. The effect of citicoline and DHA was transient and suggested the need of chronic intake to maintain the positive effects in the VF. A larger trial is needed to confirm this promising initial results.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.