The Glaucoma Nicotinamide Trial

SGNT: Inclusion Criteria:

• Adult participants (>18 years) with newly-diagnosed and previously untreated POAG orPEXG in one or both eyes. Glaucoma is defined as reproducible visual field (VF)defects that cannot be explained by other disease or damage, and a suspect/abnormaloptic nerve head and/or nerve fibre layer defect.
• Participants need to have visual acuity of Snellen ≥ 6/12 (0.5) or better.
• Have performed at least two reliable VFs (SITA-Fast 24-2), with <33% fixation lossesand <15% false positives

Exclusion Criteria:

• VF damage worse than -10dB in the best eye and -16dB in the worse eye or a paracentralspot with -10dB or less in any eye),
• IOP >35mmHg in any eye or a mean IOP of 30mmHg or higher (two measurements), •inability to perform VFs,
• pregnancy/breastfeeding,
• those unwilling to abstain from NAM supplements,
• allergic to NAM/niacin,
• diagnosed with cancer in the last 5 years (except treated basal or squamous cellcarcinoma),
• a history of liver disease or stomach ulcers,
• disease that prevents long-term follow-up,
• neurologic or other non-glaucomatous conditions apart from cataract that may affectthe VF, •inability to understand and speak Swedish or English,
• a history of intraocular surgery (apart from uncomplicated cataract surgery) and
• diseases that are known to affect retinal function (e.g. > mild age-related maculardegeneration, > stage I diabetic retinopathy). VBIGS: Inclusion Criteria:
• Patients aged 18 years or older, with definitive, treated POAG including normaltension glaucoma, PEXG in both eyes
• Best-corrected visual acuity ≥ 6/18
• Severity of visual field loss, MD between -3 and -18 dB. This range includes peoplewith moderate disease which optimises detection of progression.
• Patient must have performed at least two reliable VFs (24-2), with <33% fixationlosses and <15% false positives.
• Previous selective laser trabeculoplasty is acceptable (IOP-lowering laser treatment)if 3 or more months prior, and normal liver function tests.
• Those taking NAM already will undergo a 1-month washout period before commencing thestudy. Exclusion Criteria:
• Patients with a history of hepatic disease, gout, visually significant cataracts,other conditions that can affect VF results, cataract surgery in the last 3 months orglaucoma filtration surgery in last 6 months.