This retrospective cohort study used propensity score-matched (1:1) EMR data from 67 US health systems (2006–2026) to evaluate whether systemic nicotinamide supplementation in adults with ocular hypertension (OHT) reduces risk of conversion to primary open-angle glaucoma (POAG) and delays need for escalated treatment, compared to controls with no nicotinamide/niacin use over a mean follow-up of 3.7 years.
POAG developed in 3.5% of the nicotinamide group vs 9.0% of controls (HR 0.34; 95% CI 0.25–0.47; absolute risk reduction 5.5%). Initiation of topical IOP-lowering therapy was also lower (13.6% vs 21.2%; HR 0.57), as was laser trabeculoplasty (0.8% vs 1.9%; HR 0.38).
- Observational design cannot establish causality; residual confounding likely despite propensity matching. - Nicotinamide dose, formulation, duration, and adherence were not captured from EMR data. - Supplement use may be under-documented in EMRs, risking misclassification of exposure or control status.
In OHT patients, systemic nicotinamide was linked to a roughly two-thirds lower rate of POAG diagnosis over ~4 years — a clinically meaningful signal, but not yet proof of causation. Clinicians may consider discussing nicotinamide as an adjunct while awaiting prospective trial data.
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