NR vs NMN vs Nicotinamide for Glaucoma: Which NAD+ Booster Has the Strongest Evidence?

This audio article is from VisualFieldTest.com.Read the full article here: https://visualfieldtest.com/en/nr-vs-nmn-vs-nicotinamide-for-glaucoma-which-nad-booster-has-the-strongest-evidenceTest your visual field online: https://visualfieldtest.comSupport the show so new episodes keep coming: https://www.buzzsprout.com/2563091/supportExcerpt:NAD+ and Glaucoma: Why Vitamin B₃ Matters Glaucoma is an aging-related eye disease in which retinal ganglion cells (RGCs) – the nerve cells that carry visual signals from the eye to the brain – gradually die off. Pressure-lowering treatments (drops, lasers, surgery) are the standard of care, but many patients still experience slow vision loss. Researchers have therefore been exploring additional neuroprotection strategies. One promising idea is boosting NAD+ (nicotinamide adenine dinucleotide) – a vital cell energy molecule – because NAD+ levels naturally decline with age (). Lower NAD+ may leave RGCs less able to meet their high energy needs, especially under glaucoma stress. In fact, one lab review notes that “glaucoma is a neurodegenerative disease in which neuronal levels of NAD decline,” and shows that nicotinamide (vitamin B₃) can protect RGCs in multiple animal glaucoma models (). This finding has inspired human trials of NAD-boosting supplements in glaucoma. Current research has focused on three NAD precursors: nicotinamide (vitamin B₃), nicotinamide riboside (NR), and nicotinamide mononucleotide (NMN). All three are natural forms of B₃ that feed into the NAD+ salvage pathway (). Nicotinamide (often called niacinamide) is a form of vitamin B₃ found in foods and multivitamins; NR and NMN are specialized NAD precursors found in small amounts in some foods (and sold as supplements). But do they really help glaucoma? Below we compare what is known about each one in plain language. All claims below are backed by recent science and trials. Nicotinamide for Glaucoma Why is nicotinamide being studied? Researchers study nicotinamide because it directly boosts NAD+ via the cell’s salvage pathway and has strong lab evidence in glaucoma models. In aging cells, NAD+ “declines with age at a systemic level” (). RGCs are very energy-hungry cells in a high-stress environment (high pressure can damage mitochondria inside them). Boosting NAD+ could supercharge RGC metabolism and help them survive. In rodent glaucoma experiments, high-dose nicotinamide dramatically protected RGC bodies and axons. For example, Tribble et al. (2021) report that dietary nicotinamide blocked the early metabolic disruptions caused by high eye pressure and improved mitochondrial function in rat retinas (). In simple terms, vitamin B₃ helped the energy cells in the retina keep working properly under stress. This strong preclinical data has given researchers confidence to try nicotinamide in human glaucoma. Human trial evidence for nicotinamide Human studies are still small but encouraging. A 2022 trial in open-angle glaucoma (with moderate field loss) gave patients high-dose nicotinamide plus another agent (pyruvate). Participants took 1–3 grams of nicotinamide daily. Over ~2 months, the treatment group showed significantly more improvement in visual field test points than placebo did (). Specifically, the median number of improved field locations was 15 in the nicotinamide group versus 7 in placebo (p=0.005) (). Secondary measures of field sensitivity also tended to improve more with treatment. Although this trial was short and combined with pyruvate, it provides a positive signal that NAD boosting can hSupport the show