Fight for Sight-funded study uncovers how a potential new treatment for glaucoma might work

What is glaucoma?

Glaucoma is characterised by damage to cells in the optic nerve, the nerve that connects the eye to the brain, enabling vision. Specifically, it causes dysfunction and death in cells known as ‘retinal ganglion cells’. These are the cells that transport information from the eye to the visual processing centres in the brain.

Currently, the only approved way to manage glaucoma is through lowering pressure in the eye, but these treatments don’t work for everyone, and they don’t address the neurodegeneration that is a hallmark of the disease. The term 'neurodegenerative disease' encompasses any disease that is characterised by progressive damage to your central nervous system. 

Could a form of vitamin B3 be used to treat glaucoma?

The optic nerve uses a lot of energy. That’s why recent research has investigated the potential therapeutic effects of something called ‘nicotinamide’ (otherwise known as NAM; a form of vitamin B3 that’s found in the diet or supplements).

To put it simply, NAM can help to increase the amount of energy our cells have. Seeing as the cells damaged in glaucoma require a lot of energy to function, it was hypothesized that using NAM as a treatment could help prevent or even treat damage in people with glaucoma. This idea has been successfully translated into two early-stage clinical trials. 

How might this treatment work?

A recent Fight for Sight-funded study led by Professor James Morgan at Cardiff University has provided new information on how NAM might work in glaucoma treatment. Findings suggest that it’s a particular part of these retinal ganglion cells, the part that can be regenerated, that could be protected by NAM. This part is known as the cell’s ‘dendrites’.

Dendrites are the tree-like branches at either end of a neuron that are responsible for communicating with other cells. The team found that dendrites become damaged early in glaucoma, but that NAM could provide preventative protection, or even reverse damage.

What’s next?

The right stage for treatment still needs to be established, but these results suggest that dendrites specifically could be a target for recovering vision in glaucoma. By understanding how a potential treatment works, we can get a better idea of how to refine the treatment going forward.

The ongoing clinical trials need to be finalised for us to have clear evidence that NAM is protective in glaucoma patients, and that it improves symptoms of the condition. Existing glaucoma patients should consider consulting with their own primary care doctor or ophthalmologist before starting nicotinamide therapy for themselves.