Abstract
Purpose :
Age-related bioenergetic insufficiency increases retinal ganglion cell (RGC) vulnerability to intraocular pressure (IOP) in glaucoma. Nicotinamide and pyruvate supplementation has recently gained traction with evidence of short term neuro-enhancement in patients with treated, manifest glaucoma. Here we sought to evaluate the tolerability and efficacy of nicotinamide and pyruvate oral supplementation for primary open angle glaucoma (POAG) in a real-world setting.
Methods :
Non-comparative case series. We performed a retrospective chart review of patients attending the Byers Eye Institute at Stanford referral glaucoma clinic who were offered oral nicotinamide and pyruvate alongside standard care (IRB protocol number 69864). The acceptance rate, side effect profile and reason for discontinuation were assessed. Efficacy measures included visual acuity, IOP, global retinal nerve fiber layer thickness, ganglion cell complex thickness, and global visual field progression.
Results :
A pilot sample of 16 POAG patients (14 male, 2 female; mean age 69.8±2.76 years; mean MD at initiation -17.4±3.30 dB OD and -15.9±3.28 dB OS) was identified. The mean duration of supplementation was 16.1± 2.46 months. 50% (8/16 patients) of those on nicotinamide also took pyruvate. 18.8% (3/16 patients) reported side effect profile as a reason for discontinuation. Lack of perceived efficacy was also cited. 81.2% were continuing at the most recent follow up. There was no significant change in visual acuity, IOP, retinal nerve fiber layer thickness or ganglion cell complex thickness after supplementation. There was a trend towards improvement in the global rate of MD progression after supplementation.
Conclusions :
POAG patients show strong interest in non-invasive adjunctive strategies alongside IOP-lowering standard care. Nicotinamide and pyruvate are well tolerated in the medium-term with a low incidence of reported side effects and low rate of discontinuation. Global parameters of structure or function did not demonstrate significant change with supplementation. Work is ongoing to assess regional and pointwise functional variation, as well as correlation with metabolic biomarkers of mitochondrial function, blood flow at the optic nerve head and electrophysiological parameters of RGC function.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.