• Posted July 16, 2024

How to Predict Who Will Respond to Glaucoma Treatment -- and Who Won't

An experimental blood test might be able to predict whether glaucoma patients will continue to lose their vision following treatment, researchers report.

A biochemical called nicotinamide adenine dinucleotide (NAD) tends to be lower in people with glaucoma compared to those without the eye disease, researchers found.

What’s more, glaucoma patients with lower NAD levels than others tended to lose their vision more quickly, even after receiving treatment to lower fluid pressure in the eye.

A clinical test based on NAD levels “would enable clinicians to predict which patients are at higher risk of continued vision loss, allowing them to be prioritized for more intensive monitoring and treatment,” said senior researcher David Garway-Heath, a professor with the University College London Institute of Ophthalmology.

NAD is made from the vitamin B3 and is linked to how much oxygen is used by blood cells in the body, researchers explained.

Glaucoma occurs when pressure builds up inside the eye, damaging the optic nerve that sends signals from the eye to the brain. As nerve cells die, vision diminishes until patients eventually go blind.

For this study, researchers studied 139 people receiving standard treatment for glaucoma, which involves medication or surgery intended to lower the fluid pressure within the eyeball.

They compared those glaucoma patients to 50 people with good eye health.

The team found that people with lower levels of NAD tended to have lower oxygen use in their white blood cells, and these folks tended to lose their vision faster when they had glaucoma -- even if they were receiving standard treatment to lower eye pressure.

NAD measurement explained 13% of the difference in how fast glaucoma patients lost vision, researchers report.

The new study was published recently in the journal Nature Medicine.

The findings open the door for new treatments for glaucoma based on boosting cell health by improving the function of mitochondria, the powerhouses inside cells that produce the energy they use to function, researchers said.

University College London (UCL) is now leading a major clinical trial “to establish whether high-dose vitamin B3 can boost mitochondrial function and reduce vision loss in glaucoma,” Garway-Heath said in a UCL news release. “We hope that this will open a new avenue for treatment of glaucoma patients which does not depend on lowering the eye pressure.”

More information

The American Academy of Ophthalmology has more on glaucoma.

SOURCE: University College London, news release, July 12, 2024