A recent large study found that vitamin B3 (nicotinamide) supplements may help in preventing glaucoma (specifically primary open-angle glaucoma) and also need fewer treatments (e.g., eye drops and laser procedures) in those with glaucoma.
Glaucoma refers to many diseases involving eye pressure increases and damage to the optic nerve, which can result in permanent vision loss and blindness. Primary open-angle glaucoma (POAG) is the most common form of glaucoma. The study found that those taking nicotinamide supplements had a 66% lower risk of developing glaucoma.
Since the study is behind a paywall, I've included summaries (each a little different) from 2 web-sites describing the study.
From Medical Xpress: Could vitamin B3 prevent silent thief from stealing vision? New study finds protective effects against glaucoma
Often called the silent thief of sight, glaucoma is a group of eye diseases that gradually damage the optic nerve, often without warning signs. It is linked to increased pressure (ocular hypertension) inside the eye and, if left untreated, can lead to permanent vision loss. Even with ongoing treatment, some people still face the risk of progressive vision loss.
This led scientists to look for newer therapeutics that can help manage the disease's progression, such as nicotinamide, a form of vitamin B3.
In a recent study, researchers conducted a large-scale data analysis to investigate whether nicotinamide could help prevent or delay the onset of primary open-angle glaucoma (POAG) in high-risk patients.
They identified 2,920 patients who had ocular hypertension but had not yet developed glaucoma; half were taking nicotinamide, and the others were not. The comparison revealed that those taking the vitamin had a 66% lower risk of developing glaucoma. Over about 3.7 years, only 3.5% of nicotinamide users developed the disease, compared with 9% of nonusers.
Scientists have recently realized that glaucoma is a metabolic disease. As people age, their levels of a molecule called nicotinamide adenine dinucleotide—a coenzyme that helps cells produce energy and repair DNA—naturally drop, leaving retinal cells in the eye short on energy and vulnerable to damage.
Nicotinamide helps replenish this coenzyme and subsequently supports repair and improved blood flow in the eyes. So far, most studies have focused on whether nicotinamide supplements can protect damaged optic nerve cells and improve vision in people with glaucoma. What researchers didn't know was whether the supplement could also help prevent the disease from developing in people with ocular hypertension.
For this study, researchers analyzed anonymous electronic health records collected from 67 health care organizations across the United States over 20 years, from March 2006 to March 2026. They focused on people with ocular hypertension who had not yet been diagnosed with glaucoma.
To make the comparison as fair as possible, they used a method called propensity score matching, pairing each person taking nicotinamide with a closely matched participant of the same age, sex, medical history and eye condition who was not taking the supplement.
They tracked the two matched groups for 3.7 years to answer three main questions: Did participants officially develop glaucoma? Did they need to start using prescription eye drops to lower eye pressure? Did they require laser therapy?
High-risk patients taking nicotinamide were significantly less likely to develop glaucoma or need more intensive treatment than those who did not take the supplement. Only 13.6% of people in the nicotinamide group needed prescription eye drops to lower eye pressure, compared with 21.2% of those who were not taking it.
Those who did not take the supplement were also more than twice as likely to require laser treatment for glaucoma. The protective effect was seen even among patients who started taking nicotinamide only after being diagnosed with high eye pressure.
While nicotinamide is not a replacement for standard glaucoma care, these findings suggest it could help delay the onset of POAG and reduce the need for treatment after diagnosis. Since this was an observational study, it cannot prove that nicotinamide was directly responsible for the benefits.
From Medscape (the medical site): High Eye Pressure? Vitamin B3 May Shield Against Glaucoma
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
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- 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
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- Over a mean follow-up of 3.7 years, 51 patients taking nicotinamide developed POAG compared with 132 not taking the supplement, 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, 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.
“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.
NOTE: The records did not show the exact dose, type of product, or how often people took it, and the best protective dose is still unknown.