Four articles. Four minutes. | Issue #14
Nutrition: Nicotinamide plus pyruvate was associated with localized arcuate visual field improvement missed by global mean deviation
Medication: Suprachoroidal triamcinolone carried IOP elevation risk similar to intravitreal dexamethasone in noninfectious uveitis
Epidemiology: Calcium channel blocker use was associated with coded progression to severe POAG, but causality remains uncertain
Diagnostics: Plateau iris, narrower angles, and higher baseline IOP identified PACS eyes at greater 5-year progression risk
A Topographical Analysis of Visual Field Improvement in a Phase 2 Randomized Trial of Nicotinamide and Pyruvate for Open-Angle Glaucoma.
Methods
This post hoc analysis included 32 eyes from a single-center phase 2 randomized, double-blind trial of nicotinamide plus pyruvate (up to 3 g/day each; 21 eyes) versus placebo (11 eyes). Using 4 baseline and 4 post-baseline 24-2 visual field tests over approximately 7 weeks, the authors assessed whether severity-stratified pointwise total deviation slopes detected localized improvement missed by global indices.
Results
Treated eyes had more visual field locations classified as improving than placebo (pooled OR 3.73, 95% CI 2.36-5.89, P < 0.001), clustering along arcuate retinal nerve fiber layer pathways and in moderate-to-deep defects. A Bayesian model estimated a 98.4% probability of treatment benefit, and improvement was unrelated to cognitive change.
Conclusion
Severity-stratified pointwise analysis detected localized, treatment-associated visual field improvement that was not apparent in global mean deviation. However, this post hoc finding from 32 eyes over approximately 7 weeks, using an internally defined threshold, does not establish durable neurorecovery and requires confirmation in a larger trial.
Our Angle
The practical significance of this study is less about changing treatment today and more about how we should evaluate future neurorecovery therapies. IOP lowering remains the foundation of glaucoma care, but some patients continue to lose function despite apparently adequate pressure control. A metabolic strategy that restores function in stressed (but still viable) retinal ganglion cells could eventually complement pressure lowering, particularly in eyes with documented progression. These data are intriguing, but they do not yet justify prescribing high-dose nicotinamide and pyruvate outside a clinical trial.
The study also suggests that global mean deviation may be an insensitive primary endpoint for early neurorecovery trials. Future studies should prespecify topographical and severity-adjusted analyses, use independently validated thresholds, and determine whether localized gains persist after treatment and translate into meaningful visual function. Larger trials must also establish dosing, systemic safety, and whether any short-term improvement ultimately slows long-term visual field loss.
Medication
Intraocular Pressure Elevation After Suprachoroidal Triamcinolone Acetonide in Noninfectious Uveitis: An IRIS Registry Study.
Design: Retrospective propensity-score-matched cohort study
Journal: Ophthalmology Glaucoma, July 2026
Authors: Nabavi A et al.
In a propensity-matched IRIS Registry study of 2,370 eyes with noninfectious uveitis, suprachoroidal triamcinolone acetonide (790 eyes) and dexamethasone intravitreal implant (790 eyes) both raised IOP at similar rates over 12 months: 25.7% and 24.7% of eyes reached at least 24 mmHg, compared with 12.0% of systemic-therapy controls (HR 2.21 and 2.11, respectively). IOP of at least 30 mmHg occurred in roughly 10% of both corticosteroid groups. Suprachoroidal delivery did not lower real-world IOP risk relative to dexamethasone, supporting similar pressure monitoring. Residual confounding, repeat steroid exposure, non-eye-specific medication data, and absent gonioscopy, OCT, and visual fields limit interpretation.
Epidemiology
Risk of Glaucoma Progression in Patients Using a Calcium Channel Blocker: A Propensity-Matched Cohort Study.
Design: Retrospective propensity-score-matched cohort study
Journal: Investigative Ophthalmology & Visual Science, May 2026
Authors: Qozat I et al.
In a propensity-matched TriNetX cohort of 7,446 patients with mild or moderate primary open-angle glaucoma, both dihydropyridine and nondihydropyridine calcium channel blocker classes were associated with more coded progression to severe disease than matched nonuse (3.5% vs 2.1%; RR 1.67 and 6.9% vs 1.9%; RR 3.62). However, progression relied on ICD-10 codes, and the database lacked IOP, visual fields, procedures, blood pressure control, dose, duration, and adherence, leaving substantial residual cardiovascular confounding. This finding supports medication reconciliation and further study, not changing medically indicated antihypertensive therapy.
Diagnostics
Factors Associated With Progression to Primary Angle Closure: A Post Hoc Analysis of the ANA-LIS Trial.
Design: Post hoc analysis of a randomized clinical trial
Journal: JAMA Ophthalmology, July 2026
Authors: Tun TA et al.
In a post hoc ANA-LIS analysis, 16 of 322 primary angle-closure suspect eyes (5.0%) with baseline anterior segment OCT and ultrasound biomicroscopy progressed to primary angle closure over 5 years. Plateau iris in at least one quadrant carried a hazard ratio of 11.1 after adjusting for baseline IOP, and each 0.1 mm2 decrease in trabecular-iris space area at 750 micrometers was associated with a 3-fold higher risk. Higher baseline IOP was also independently linked to progression. The small event count, wide confidence intervals, and availability of baseline imaging in only one-third of the original cohort preclude routine ultrasound-based risk stratification without validation.
Glaukos enrolls at least 110 patients in a 510(k) pivotal study of the PRESERFLO MicroShunt, an ab externo drainage device, for open-angle glaucoma after unsuccessful prior surgery.
The European Medicines Agency's drug committee recommends a refillable ranibizumab implant for neovascular age-related macular degeneration, advancing it toward a European Commission authorization decision.
IPG Photonics offers €300 million in cash, plus up to €50 million in contingent payments, for Lumibird Medical and its glaucoma, retina, cataract, and dry eye laser portfolio.
PRIMA, a CE-marked subretinal implant paired with specialized glasses, begins its European commercial launch for central vision loss from geographic atrophy, with the first procedure expected in Germany.
Isaac Newton experimented on his own eye by inserting a bodkin behind the globe to demonstrate that:
A. The lens could be manually repositioned
B. Mechanical pressure on the retina produces phosphenes
C. The aqueous humor circulates continuously
D. The optic nerve transmits both pain and vision
See answer at bottom of newsletter
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The Open Angle is a weekly glaucoma research digest for busy eye care professionals.
Four articles worth knowing, in under four minutes.
Edited by Jella An, MD, MBA and Jason Dossantos, MD.
The Open Angle is an educational editorial product. It is not medical advice. Readers should review original sources before changing practice.
Trivia Answer: B