Best glaucoma supplements to treat and prevent glaucoma

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What are the best glaucoma supplements to complement your existing glaucoma treatment? In this article, I have listed five of the best glaucoma supplements to enhance your optic nerve health.

However, before we discuss what these supplements are, let's find out a bit more about glaucoma first.

What is glaucoma and why is it important?

Glaucoma is a condition where there is progressive damage to the optic nerve, usually related to high pressure in the eye. This causes visual field loss and if untreated, eventual blindness.

Glaucoma is the second commonest cause of blindness worldwide, and affects at least 2% of the population. It is a major eye health issue, and the most worrying thing is that most sufferers do not know that they have this condition.This is because you usually do not notice any glaucoma symptoms until a lot of glaucoma damage has already occurred.

Unfortunately, glaucoma cannot be cured or reversed, despite the many claims to the contrary that are widespread throughout the internet. There is no cure for glaucoma and any vision lost from the optic nerve damage cannot be recovered.

It is widely accepted that glaucoma causes the retinal ganglion cells of the optic nerve to become permanently and irreversibly damaged. It is the progressive damage to the ganglion cells that eventually leads to blindness.

(Image adapted from the internet)

The only clinically proven glaucoma treatment available currently is to reduce the eye pressure. Pressure reduction can be achieved through eye drops, laser, or surgery.

Please remember that reducing the eye pressure does not cure your glaucoma or fully restore your vision; it only serves to slow down and reduce the risk of further eyesight deterioration.

Hence the focus on monitoring: early detection means early glaucoma treatment and better prevention from glaucoma blindness.

What are the best glaucoma supplements?

Many nutritional supplements and vitamins have been investigated as a potential treatment for glaucoma.

However, only some have shown promise.

Here I list five of the best glaucoma supplements that will give your optic nerve and retinal ganglion cells a big boost against glaucoma.

All five have been studied in randomized clinical trials, and have been proven to able to treat glaucoma and help prevent glaucoma blindness.

In alphabetical order, my top-five best glaucoma supplements are: bilberry-maritime pine bark combination (Mirtogenol), citicoline (Cognizin), ginkgo biloba, palmitoylethanolamide (PEA), and vitamin B3 (nicotinamide).

1. Bilberry-maritime pine bark combination (Mirtogenol)

Mirtogenol is a patented combination of standardized bilberry extract (Mirtoselect) and French maritime pine bark extract (Pycnogenol). The standard dose is 120 mg per tablet (comprising 80 mg Mirtoselect and 40 mg Pycnogenol) taken twice daily.

Mirtogenol is among the few supplements that have actually demonstrated a significant reduction in eye pressure in randomized clinical trials. It can be combined with standard glaucoma treatment to further enhance pressure reduction.

The results of a trial published in 2008 found that Mirtogenol reduced eye pressure and improved ocular blood flow in individuals with high eye pressure.

After 3 months of treatment with Mirtogenol taken twice daily, the eye pressure decreased by an average of 3 mmHg, in almost all (19 out of 20) subjects). There was no change in pressure in the control group.

The combination of Mirtogenol and latanoprost eye drop achieved even better pressure reduction than either alone, from 38 mmHg to 24 mmHg, after 6 weeks. The pressure lowering effect was maintained until the end of the study period of 6 months. At the end of the study, 58.1% of the subjects treated with Mirtogenol and latanoprost had normal eye pressure levels (compared with 41.4% in the latanoprost-only group).

Mirtogenol has a very good safety profile. However, it can theoretically increase the risk of bleeding and hypoglycemia (low blood sugar).

I do recommend Mirtogenol to my patients who need better eye pressure control, but with caution for those taking blood thinning or diabetes medications.

2. Citicoline (Cognizin)

Citicoline (also known as cytidine 5'-diphosphocholine) is a compound that is naturally found in our brain. It enhances communication between nerve cells, protects neural structures, and supports healthy brain activity.

Citicoline is tolerated very well, and has minimal or absent side effects, with virtually no toxicity. It has been authorized as a food supplement in the United States and in the European Union. The Italian Ministry of Health has approved citicoline as a supplement for special medicinal purposes in glaucoma patients.

Cognizin is a patented, clinically-tested form of ultra-pure citicoline. It is the Cognizin form of citicoline that has mainly been researched for its benefits as a form of glaucoma treatment.

Oral citicoline 500 mg (in the form of a solution) was able to significantly slow down progression of glaucoma when taken over a period of 2 years.

A separate trial found that glaucoma patients who took 500 mg oral citicoline daily had improved visual fields and nerve thickness measurements after 12 to 18 months.

No serious adverse effects were found in these trials.

Given that citicoline has an excellent safety profile and very promising results for glaucoma, I am very comfortable suggesting citicoline to my patients to help stabilize their glaucoma.

Citicoline is probably most beneficial for those in whom their glaucoma is getting worse despite the eye pressures being well-controlled medically or with laser.

3. Ginkgo biloba

Ginkgo biloba is a popular natural herb that has been used for centuries in Traditional Chinese Medicine. It contains a complex mixture of at least 37 phytochemicals in 2 main groups: flavonoids (which have antioxidant properties) and terpenoids (which have blood thinning properties).

The beneficial effects of ginkgo in glaucoma (particularly low pressure glaucoma) are likely due to a combination of its antioxidant and anti-inflammatory properties, as well as its ability to increase blood flow to the optic nerve and brain.

A trial published in 2003 found that for low pressure glaucoma patients, 40 mg of ginkgo biloba extract 3 times daily (120 mg total dose per day) taken for four weeks was able to improve pre-existing visual field loss.

A separate trial found that a ginkgo biloba blend (Optic Nerve Formula) taken 2 capsules twice daily for one month, significantly improved blood flow to the retina and optic nerve.

I usually recommend it to patients whose glaucoma continues to deteriorate despite achieving low eye pressure with medical treatment at a dose of 120 mg daily. In severe glaucoma, I will increase the dose to 160 mg daily.

The main risk of ginkgo biloba is the potential increased risk of bleeding. The scientific evidence for this is conflicting, with some case reports of severe bleeding from ginkgo, while other systematic reviews and meta-analyses have found no increase in bleeding risk.

At present, I only recommend ginkgo biloba to my patients if they are not on any blood-thinning medications.

4. Palmitoylethanolamide (PEA)

Palmitoylethanolamide, or PEA, is an endocannabinoid (or endogenous fatty acid amide) that is naturally produced throughout our body to reduce pain and inflammation in response to tissue damage and injury.

PEA is a similar-looking molecule to delta-9-tetrahydrocannabinol (which is the main active ingredient in marijuana).

The great thing about PEA is that it has a lot of the benefits of cannabis but without any of the side effects. This means you won't get addicted to PEA if you decide to take oral PEA supplements.

In fact, PEA supplements have been approved in Italy and Spain as a food supplement for special medicinal purposes.

In 2011, a well-designed randomized clinical trial reported that for glaucoma patients using timolol eye drops, PEA taken 300 mg twice daily was able to reduce eye pressure by an additional 16%.

A separate clinical trial found that ultramicronized PEA 300 mg taken twice daily for 6 months was able to reduce eye pressure and also improve visual field parameters in patients with low pressure glaucoma.

What I particularly like about PEA is its ability to reduce eye pressure and also potentially help to preserve (or even improve) the visual field and optic nerve ganglion cell function.

I am very comfortable for my glaucoma patients to take PEA to supplement their existing glaucoma treatment. Some ophthalmology departments in Italy already routinely recommend that their glaucoma patients take PEA supplements in addition to their usual glaucoma treatments.

I think PEA at a dose of 600 mg daily will be beneficial regardless of whether you have high pressure or low pressure glaucoma. If you have advanced glaucoma, you can increase the dose to 1,200 mg daily.

5. Vitamin B3 (Nicotinamide)

Vitamin B3 is a water-soluble vitamin, with nicotinamide being its active form. It plays an important role in supporting cell metabolism, mitochondrial health, and DNA repair. Vitamin B3 is naturally found in lean meat, milk, fish and nuts, and is commonly added to cereals and other foods.

In 2020, a world-first clinical trial conducted by the Centre for Eye Research Australia (CERA) reported results confirming that nicotinamide (Insolar) 3,000 mg daily significantly improved the function of the optic nerve ganglion cells (measured using electroretinography), thereby protecting against nerve damage in glaucoma.

A separate trial published in 2021 found that in treated moderate open angle glaucoma patients, a combination of oral nicotinamide (1,000 to 3,000 mg) and pyruvate (1,500 to 3,000 mg) was able to significantly improve visual function when taken over 2 months.

No serious adverse effects were reported with the nicotinamide-pyruvate combination. Insolar was not used in this trial.

In my clinical practice, I have been recommending vitamin B3 nicotinamide to some, not all, of my glaucoma patients.

I usually recommend it to patients who are at risk of their glaucoma deteriorating: 3,000 mg daily for moderate to severe glaucoma (with additional pyruvate 1,500 mg daily for severe glaucoma), and 1,500 mg daily for mild glaucoma.

Stable glaucoma patients do not really require vitamin B3 nicotinamide supplements.

The specific brand used in the Australian trial was Insolar, which is manufactured by Blackmores and is available through Amazon Australia.

Should I take all five supplements to treat my glaucoma and prevent glaucoma blindness?

Unfortunately, there is no one single supplement that can do everything.

Yes, you can take all of the five best glaucoma supplements if you wish, but please make sure to discuss with your eye specialist and family doctor first to avoid adverse drug interactions and unwanted side effects.

Apart from side effects, another consideration is cost. These supplements are not cheap and costs can mount if you are going to take all five supplements over the long-term.

The final consideration is whether you need all the five best glaucoma supplements. Each supplement on its own will give your optic nerve health a boost. Taking one or two is fine, but taking all five is probably overkill, especially if your glaucoma is stable on current treatment.

If your glaucoma is progressively getting worse despite treatment, then yes, go for it. Your optic nerve will need all the help it can get.

Remember that the purpose of glaucoma supplements are to enhance, and not replace, your existing glaucoma treatment.

If you wish to combine your glaucoma treatment with one of the best glaucoma supplements discussed above, below are highly-rated and recommended products that are available for you to purchase through Amazon:

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