Understanding Glaucoma from a Metabolic Perspective
Glaucoma is one of the leading causes of vision loss worldwide. It develops gradually, damaging the optic nerve and, if left untreated, can lead to permanent blindness. Traditionally, treatment focuses on lowering eye pressure using drops, laser therapy, or surgery. But new research suggests that specific B vitamins may also play a role in protecting vision, offering a potential new tool in glaucoma management.
Scientists at Karolinska Institute recently explored how metabolism in the eye might be connected to glaucoma. Their findings, published in Cell Reports Medicine, show that certain metabolic changes in the retina may be linked to the disease’s progression. They focused on how the retina processes homocysteine, a natural compound in the body influenced by B vitamins.
Homocysteine has long been thought to contribute to glaucoma; however, the study revealed a different perspective. When researchers raised homocysteine levels in rats with glaucoma, the condition didn’t worsen. In people, high blood levels of homocysteine were not associated with faster disease progression either. These results led scientists to believe that while homocysteine levels change during glaucoma, the real issue may be how the retina is using key nutrients, especially B vitamins.
The Role of B Vitamins and Choline
The researchers discovered that glaucoma may interfere with the retina's ability to use vitamins like B6, B9 (folic acid), B12, and choline. These nutrients play an essential role in the eye’s cellular energy production and repair processes. When the retina can’t access or use them properly, its energy metabolism slows down, which may play a role in optic nerve damage.
To test this idea, the team conducted animal studies. Mice and rats with glaucoma were given supplements containing B6, B9, B12, and choline. The results were encouraging:
- In mice with slowly progressing glaucoma, optic nerve damage was completely halted.
- In rats with more aggressive disease, the progression slowed significantly.
Interestingly, these improvements happened without modifying intraocular pressure, pointing to a separate pathway of action.
Thanks to these promising results, the researchers have launched a clinical trial at St Erik's Eye Hospital in Stockholm. The study will assess whether this specific mix of B vitamins and choline can help people with glaucoma in the same way it helped animals. While it's too early to conclude clinical use, the early findings offer hope for a new approach to supporting optic nerve health.
What This Could Mean for Patients
If future clinical trials confirm these findings, supplementing with vitamins B6, B9 (folic acid), B12, and choline could offer a new layer of support in glaucoma care. This nutritional approach may be especially valuable for patients whose disease continues to progress despite having normal eye pressure, a common and frustrating challenge in glaucoma management.
They may help sustain vital metabolic processes in the retina, potentially slowing optic nerve damage. While vitamin supplementation is not a substitute for conventional treatments such as eye drops, laser therapy, or surgery, it may work alongside these methods to offer more comprehensive protection for long-term eye health.
For patients looking for additional ways to support their vision, a targeted nutritional strategy could eventually become part of a personalised care plan. However, more research is needed before such supplements are recommended as standard treatment.
The Future of Glaucoma Care: Could Nutrition Play a Bigger Role?
As research continues to evolve, the link between nutrition and eye health is becoming harder to ignore. While traditional glaucoma treatments like eye drops, laser therapy, and surgery focus on lowering intraocular pressure, new findings suggest that supporting the retina’s metabolic health may also be key to slowing disease progression. Vitamins B6, B9 (folic acid), B12, and choline have shown promise in animal studies for helping preserve optic nerve function, even when eye pressure remains untreated. These nutrients appear to play a role in how efficiently the retina processes energy, which is critical for maintaining healthy vision. Although more clinical trials are needed, this approach represents a shift toward more holistic glaucoma care, one that considers both mechanical and metabolic factors. For individuals living with glaucoma or at higher risk, nutritional support may one day become a valuable addition to standard treatment.
References:
Karolinska Institutet. Sweden, "Vitamin supplements slow down the progression of glaucoma." ScienceDaily, 8 May 2025.