What the AAO's New NAD+ Statement Means for You

If you have glaucoma, you have probably spent more time than you would like Googling supplements. You have read contradictory advice, sifted through marketing claims, and wondered if any of it is real. So when two of the most respected eye organizations in the United States issue a formal statement about a supplement for glaucoma, that is worth paying attention to.

In January 2025, the American Glaucoma Society (AGS) and the American Academy of Ophthalmology (AAO) published a joint position statement on nicotinamide for glaucoma neuroprotection. It was the first time either organization formally addressed a nutritional supplement's potential role in protecting the optic nerve. Here is what they said, what the science behind it actually shows, and what it means for you.

What Is Nicotinamide and Why Does It Matter for Glaucoma?

Nicotinamide is a form of vitamin B3. Your body uses it to produce a molecule called NAD+, which is essential for cellular energy production. Think of NAD+ as the fuel that keeps tiny power generators inside your cells running. When NAD+ levels drop, cells struggle to produce enough energy to survive.

This matters for glaucoma because the cells most vulnerable to the disease, retinal ganglion cells, are extraordinarily energy-hungry. These are the nerve cells at the back of your eye that bundle together to form the optic nerve and carry visual information to your brain. They need a constant supply of energy just to do their job.

Research over the past decade has shown that NAD+ levels decline in the retina with age and in glaucoma. When those levels drop, retinal ganglion cells become more vulnerable to damage, even when eye pressure is controlled. That finding opened a new question: could boosting NAD+ levels help protect these cells?

What Does the AGS/AAO Position Statement Actually Say?

The joint statement acknowledges that nicotinamide supplementation has shown promising early results for glaucoma neuroprotection. That is significant. These organizations are careful with their language and do not make statements lightly.

Here is a summary of their key points.

The science is promising but early. Multiple studies in animal models have demonstrated robust neuroprotective effects. In the DBA/2J mouse model (a widely used model for age-related glaucoma), nicotinamide supplementation prevented glaucoma development in 93% of eyes at the highest tested dose.

Human trials show encouraging signals. A Phase 2 randomized controlled trial at Columbia University found that oral nicotinamide (3 g/day) combined with calcium pyruvate led to statistically significant improvements in visual field test locations compared to placebo. A crossover trial in Australia demonstrated a 14.8% improvement in inner retinal function on nicotinamide versus placebo.

Large trials are underway. Over 1,300 participants are currently enrolled in Phase 3 trials across the globe, including studies in Singapore (520 participants), the United Kingdom (496 participants), and Sweden (660 participants). Results from these trials are expected between 2026 and 2027.

Safety requires attention. Two cases of liver injury were reported in clinical trials using high-dose nicotinamide. Both resolved after stopping the supplement. The statement recommends that doses under 3 g/day should involve collaboration with a primary care physician and periodic liver function testing. Doses of 3 g/day or higher are not recommended outside of clinical trials.

Nicotinamide is not approved for glaucoma. The statement is clear that this is not a treatment recommendation. It is an acknowledgment that the science warrants attention and further study.

The Studies Behind the Statement

The position statement draws on a growing body of research. Here are the key studies, so you can see the evidence for yourself.

The Columbia Phase 2 Trial (2022)

Researchers at Columbia University ran a double-blind, placebo-controlled trial with 32 glaucoma patients. Participants received ascending doses of nicotinamide (up to 3 g/day) and pyruvate (up to 3 g/day) for about two months. The treatment group showed significantly more improving visual field test locations than placebo (median 15 vs. 7, p = .005). This was a small, short-term study, but the results were published in JAMA Ophthalmology and caught the attention of the field.

The Australian Crossover Trial (2020)

A team at the Centre for Eye Research Australia enrolled 57 glaucoma patients in a crossover design, meaning each participant received both nicotinamide and placebo at different times. Inner retinal function improved by 14.8% on nicotinamide (p = .02), with 23% of participants showing improvement beyond normal variability compared to 9% on placebo. Visual field mean deviation also trended toward improvement.

The Korean Normal-Tension Glaucoma Trial (2026)

Published just this month in the British Journal of Ophthalmology, this crossover trial enrolled 53 patients with normal-tension glaucoma. After 12 weeks of nicotinamide supplementation (ramping from 1 g/day to 2 g/day), the treatment group showed significantly greater improvements in retinal function measurements compared to placebo. This is notable because normal-tension glaucoma patients already have "normal" eye pressure, which underscores the value of approaches that go beyond pressure control.

The NR Mouse Model Studies

Nicotinamide riboside (NR), another NAD+ precursor, has also been tested in animal models. A 2021 study at Emory University showed that systemic NR treatment protected retinal ganglion cells and preserved function in both acute and chronic models of retinal damage. A follow-up preprint from the same group demonstrated that long-term NR supplementation in DBA/2J mice significantly protected against retinal ganglion cell loss and optic nerve atrophy, while also delaying the rise in eye pressure associated with the disease model.

What Trials Are Happening Right Now?

One reason this moment matters is the sheer scale of research underway. Multiple large, rigorous trials are testing nicotinamide for glaucoma around the world.

The TAMING Glaucoma Study in Singapore is a Phase 3 trial with 520 participants, expected to report in 2027. The University College London trial is also Phase 3, with 496 participants and results expected in 2027. The Glaucoma Nicotinamide Trial in Sweden has enrolled 660 participants, with results expected in late 2026.

Columbia University and Stanford are running a Phase 3 trial testing nicotinamide (3 g/day) combined with calcium pyruvate (1 g/day) over 21 months. And a Phase 2 trial registered in 2025 is comparing different NAD+ precursors head-to-head, including nicotinamide riboside, nicotinamide, and nicotinamide mononucleotide, to see which form is most effective for retinal function in glaucoma patients.

That last point is particularly interesting. Most of the human data so far uses nicotinamide (plain vitamin B3). Nicotinamide riboside (NR) is a different NAD+ precursor that some researchers believe may be more efficient at raising NAD+ levels. The animal data on NR is strong, and the head-to-head comparison trial should help clarify whether the form of vitamin B3 matters.

What Does This Mean for You?

If you have glaucoma or are at risk, here is the practical takeaway.

This is real science, not hype. The fact that the AGS and AAO issued a formal statement means the evidence has reached a threshold where the medical establishment considers it worth discussing. That does not happen with most supplements.

It is not a replacement for your current care. Eye pressure management remains the foundation of glaucoma treatment. The research on nicotinamide is about adding another layer of support, not replacing what your doctor is already doing.

Talk to your eye doctor. If you are interested in nicotinamide or NAD+ supplementation, bring it up at your next appointment. With the AGS/AAO statement now published, your ophthalmologist will be familiar with the research.

Watch the dose. The position statement specifically flags liver safety concerns at high doses (3 g/day or more) and recommends liver function monitoring even at lower doses. More is not always better.

For people who want to support their cellular energy and optic nerve health as part of a proactive, long-term approach, products like Sight Guard are designed to complement your existing care. Sight Guard was formulated around the science of NAD+ and cellular energy in the eye, supporting the same biological pathways that this research is exploring.

The next 12 to 18 months will bring results from the largest nicotinamide trials ever conducted in glaucoma. We will be watching closely and will break down the findings when they arrive. For now, the message from two of America's leading eye organizations is clear: NAD+ science for glaucoma is worth your attention.

References

1. Shukla AG, Cioffi GA, John SWM, et al. American Glaucoma Society-American Academy of Ophthalmology Position Statement on Nicotinamide Use for Glaucoma Neuroprotection. Ophthalmol Glaucoma. 2025;8(2):112-116. doi: 10.1016/j.ogla.2025.01.002

2. De Moraes CG, John SWM, Williams PA, et al. Nicotinamide and Pyruvate for Neuroenhancement in Open-Angle Glaucoma: A Phase 2 Randomized Clinical Trial. JAMA Ophthalmol. 2022;140(1):11-18. doi: 10.1001/jamaophthalmol.2021.4576

3. Hui F, Tang J, Williams PA, et al. Improvement in inner retinal function in glaucoma with nicotinamide (vitamin B3) supplementation: A crossover randomized clinical trial. Clin Exp Ophthalmol. 2020;48(7):903-914. doi: 10.1111/ceo.13818

4. Ha A, Kim YK, Lee CK, et al. Effects of nicotinamide supplementation in normal-tension glaucoma: a crossover placebo-controlled randomised clinical trial. Br J Ophthalmol. 2026;110(4):417-424. doi: 10.1136/bjo-2025-328096

5. Visalli F, Cappellani F, Gagliano G, et al. Mitochondrial Resilience in Glaucoma: Targeting NAD+ Metabolism and Oxidative Stress in Retinal Ganglion Cell Degeneration with Nicotinamide Riboside and Berberine. Diseases. 2026;14(2):56. doi: 10.3390/diseases14020056

6. Zhang X, Zhang N, Chrenek MA, et al. Systemic Treatment with Nicotinamide Riboside Is Protective in Two Mouse Models of Retinal Ganglion Cell Damage. Pharmaceutics. 2021;13(6):893. doi: 10.3390/pharmaceutics13060893

7. Zhang N, Li Y, Zhang X, et al. Oral supplementation with Nicotinamide Riboside treatment protects RGCs in DBA/2J mouse model. bioRxiv. 2024. doi: 10.1101/2024.12.03.626460

8. Shukla AG, Tsamis E, De Moraes CG, et al. Nicotinamide and Pyruvate in Open-Angle Glaucoma: A Randomized Controlled Trial on Neuroprotection. Ophthalmol Glaucoma. 2025. doi: 10.1016/j.ogla.2025.12.008

9. Martucci A, Cesareo M, Pinazo-Duran MD, et al. Next-Gen Neuroprotection in Glaucoma: Synergistic Molecules for Targeted Therapy. J Clin Med. 2025;14(17):6145. doi: 10.3390/jcm14176145