I would like to know if citicoline eye drops are safe and effective for glaucoma. I especially seek feedback from real glaucoma patients who actually tried these eye drops.
The commercially available drops, as of this writing, contain benzalkonium chloride, a chemical that is often used in glaucoma eye drops, but which has been shown to be toxic to corneal epithelium cells.
Here is the composition of the current commercially available drops:
Hyaluronic acid, sodium citicoline, sodium phosphate monobasic monohydrate, sodium phosphate dibasic dodecahydrate, sodium chloride, benzalkonium chloride, and water.
Benzalkonium Chloride and Glaucoma Management Today - Glaucoma Today
BAK has become a source of controversy in the treatment of glaucoma, because BAK has been reported to accumulate in ocular tissues, causing different types of cell injury with frequent dosing. The agent is a recognized cause of corneal and conjunctival toxicity. This toxicity has been implicated to cause changes to the corneal and conjunctival surfaces, ocular discomfort, tear film instability, conjunctival inflammation, subconjunctival fibrosis, and epithelial apoptosis.3 It has been inferred that BAK damages the trabecular meshwork as well.
In addition to the problematic benzalkonium chloride, hyaluronic acid is an interesting ingredient. It can elevate intraocular pressure in some glaucoma patients. See this discussion: Can steroid-free hyaluronic acid injections in knee cause intraocular pressure spikes? | FitEyes
2020 Jul 29
doi: 10.1097/IJG.0000000000001565.
Investigators assessed whether additional therapy with citicoline eyedrops to intraocular pressure-lowering treatment could slow glaucoma progression in patients with worsening of damage and IOP 18 mmHg or less, as part of a randomized, double-masked, placebo-controlled, multicenter three-year study.
Main outcome measures were differences in visual field (MD of 24-2; MD of 10-2) rates of progression and differences in retinal nerve fiber layer thickness changes between the two study groups at three years.
Patients with mild to moderate open-angle glaucoma showing damage progression of at least -0.5 dB/y in the two years before enrollment despite IOP ≤18 mmHg were randomized to receive citicoline eyedrops or placebo three times daily for three years. Patients were followed every three months and underwent visual field exams with 24-2 and 10-2 strategies and RNFL assessment. ANOVA and linear models were used to test the differences between groups.
Eighty patients were randomized in the trial. Here were some of the findings:
Mean three-year rates of progression were:
for 24-2 MD: -1.03 (2.14) dB in the citicoline group and -1.92 (2.23) dB in the placebo group (p=0.07); and
for 10-2 MD -0.41: (3.45) dB in citicoline group and -2.22 (3.63) dB in the placebo group (p=0.02).
On average patients receiving citicoline eye drops lost 1.86 µm of RNFL in three years vs. 2.99 µm in the placebo group (p=0.02).
Investigators concluded that adding treatment with citicoline eye drops to IOP-lowering treatment might reduce disease progression in individuals with progressing glaucoma despite IOP ≤18 mmHg.
SOURCE: Rossetti L, Iester M, Tranchina L, et al. Can treatment with citicoline eyedrops reduce progression in glaucoma? The results of a randomized placebo-controlled clinical trial. J Glaucoma 2020; June 11. [Epub ahead of print].
I'm in the UK, and ordered citicoline eye drops from Italy last year after reading about the potential of Citicoline here on FitEyes.
They duly arrived, but I could not use them for longer than 2 or 3 days before the benzalkonium chloride (I presume it was this ingredient) started to cause problems.
I tried a few times to make them work but the end result was the same each time, and I soon had to stop.
I read somewhere that BAK is used to facilitate absorption into the eye by "roughening" the surface of the cornea somehow, and not just as a preservative, which is its advertised use.
If so, these drops certainly created this effect and I found them impossible to use.
If you live in the USA and try to order these citicoline eye drops, you may run into the issue I ran into:
At the moment the country to which the shipment request is not supported. The list is constantly updated.
I live in Minnesota, USA & the company is located Italy.
Hello. I have been using Citicoline eye drops since a trip to Italy about three months ago I started with Omk1 drops and used them for about two months, then recently switched to Omk2 (with B12). I'm having difficulty doing fine pencil work in the studio, like I'm looking through, or need to look around, a very light fog, and it occurred to me this might be a result of or reaction to the drops. I haven't found anything helpful online, so I don't yet know if this is a side effect of these drops.
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