Nicotinamide Riboside Oral Supplementation in Macula Off Retinal Detachment (NOMAD)

A Randomised Double-Masked Placebo-Controlled Trial of Nicotinamide Riboside Oral Supplementation in Macula Off Retinal Detachment

Retinal detachment occurs when fluid separates the retina (a thin, light sensing tissue) from its usual attachment at the back of the eye. If detached, these retinal cells lose their normal blood supply and begin to die, which is the primary cause of vision loss in retinal detachment. The 'macula' refers to the very centre of the retina, with the highest density of retinal cells, most responsible for vision. Significant vision loss occurs when this part of the retina becomes separated (termed a 'macula-off retinal detachment'). Typically, surgery is required to repair the retinal detachment.

Supporting the health of retinal cells at the macula may prolong their survival after detachment and their recovery postoperatively. Recent evidence has shown that boosting our nicotinamide adenine dinucleotide (NAD+) levels may improve the health of these cells and prolong their survival if detached. Oral Nicotinamide Riboside (NR) is converted into NAD+, and while not studied for macula-off retinal detachments, has been safely used in a range of other conditions. This study is designed to help evaluate the safety and tolerability of NR to help preserve vision in people diagnosed with macula-off retinal detachment.

This study drug is given as an oral supplement (tablet) at the time of retinal detachment diagnosis, and daily for 20 weeks thereafter. The drug aims to prolong survival of cells in the retina (and macula) and their recovery after surgery.

The long-term goal of this treatment is to reduce loss of vision after retinal detachment. The researchers will compare NR to a placebo (a look-alike substance that contains no drug) to see if NR has a positive effect on photoreceptor survival and quality of vision postoperatively.

NR has been approved by the Therapeutic Goods Administration in Australia for many purposes but has not been approved for use in retinal detachment treatment.

Study Overview

• Status: Recruiting
• Conditions: Retinal Detachment
• Intervention / Treatment: Other: Placebo; Dietary supplement: Nicotinamide Riboside; Procedure: Vitrectomy and Gas tamponade

• Study Type: Interventional
• Enrollment (Estimated): 144
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Carly Parfett; Phone Number: +61399590028; Email: cera-rgo@cera.org.au

Study Locations

• Australia
  • Victoria
    • East Melbourne, Victoria, Australia, 3002
      • Recruiting
      • Centre for Eye Research Australia
      • Contact: Carly Parfett; Phone Number: +61 03 9959 0028; Email: cera-rgo@cera.org.au
    • East Melbourne, Victoria, Australia, 3002
      • Recruiting
      • The Royal Victorian Eye and Ear Hospital
      • Contact: David Sousa, MD PhD FRANZCO; Phone Number: +61 03 9929 8666; Email: david.sousa@eyeandear.org.au
      • Principal Investigator: David Sousa
      • Principal Investigator: Penelope Allen
    • East Melbourne, Victoria, Australia, 3002
      • Recruiting
      • Cerulea
      • Contact: Flora Hui; Phone Number: +61 3 9959 0068; Email: fhui@cera.org.au
    • Geelong, Victoria, Australia, 3220
      • Recruiting
      • Dr David Fabinyi
      • Contact: David Fabinyi, MBBS FRANZCO; Phone Number: +61 419 157 350; Email: fabinyireception@gmail.com
    • Geelong, Victoria, Australia, 3220
      • Recruiting
      • Dr David Sousa
      • Contact: David Sousa, MD PhD FRANZCO; Phone Number: +61 3 5229 6300; Email: sousa.sjog@gmail.com
      • Principal Investigator: David Sousa
      • Sub-Investigator: Ben Clark

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ≥ 18 years old
• Able to give informed consent and comply with all study visits and procedures.
• Present within 10 days of macula-off retinal detachment (based on patient-reported history of loss of central vision)
• Present to the hospital with a visual acuity of hand motion or better in the study eye
• Have had previous cataract surgery in the study eye
• Have clinical indication for standard retinal reattachment surgery by means of a pars plana vitrectomy and gas tamponade
• In the opinion of the investigator, be able to safely undergo all study procedures.

Key exclusion Criteria:

• Any known significant ocular disease in the study eye (e.g., cornea opacity) which, in the opinion of the investigator, would preclude a visual acuity of at least 6/7.5 (20/25) following successful vitrectomy or limit adequate visibility of the retina.
• Any other ocular pathology in the study eye requiring treatment with topical ophthalmic drops or intravitreal injection.
• History of previous ocular surgery in the study eye other than uncomplicated cataract surgery with posterior chamber intraocular lens and intact posterior capsule or a refractive surgery (surgery must have occurred at least 3 months prior to the baseline visit).
• Participation in other clinical trials or use of any other investigational drugs or devices within 3 months prior to study participation.
• Females who are pregnant or lactating and women of childbearing potential.
• Known retinopathy, known hepatic disease (or history of significant chronic liver disease), or known renal disease. Patients Participants with diabetes and no known retinopathy may be enrolled.
• History of uncontrolled hypertension.
• History of stroke, transient ischemic attack, or major cardiac surgery within 3 months prior to study, or current treatment for systemic infection.
• Any ocular or systemic condition that in the opinion of the investigator could compromise the safety of the patientparticipant, or may interfere with the safety and tolerability assessments or study procedures of the trial.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo	Other: Placebo; Matched placebo; Procedure: Vitrectomy and Gas tamponade; Standard of care Vitrectomy surgery for retinal reattachment
Experimental: Nicotinamide Riboside; Oral Nicotinamide Riboside intake from date of presentation: 2g daily for 4 weeks followed by 1g daily for 16 weeks postoperatively	Dietary supplement: Nicotinamide Riboside; Oral Nicotinamide Riboside, 2g daily for 4 weeks followed by 1g daily for 16 weeks; Procedure: Vitrectomy and Gas tamponade; Standard of care Vitrectomy surgery for retinal reattachment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Best-corrected Visual Acuity	20 weeks postoperatively
Microperimetry	20 weeks postoperatively
Contrast sensitivity	20 weeks postoperatively

Secondary Outcome Measures

Outcome Measure	Time Frame
Integrity of the photoreceptor layer on optical coherence tomography	20 weeks postoperatively

Collaborators and Investigators

• Sponsor: Center for Eye Research Australia
• Investigators: Principal Investigator: David Sousa, MD PhD FRANZCO, Center for Eye Research Australia

Publications and helpful links

General Publications

• Trammell SA, Schmidt MS, Weidemann BJ, Redpath P, Jaksch F, Dellinger RW, Li Z, Abel ED, Migaud ME, Brenner C. Nicotinamide riboside is uniquely and orally bioavailable in mice and humans. Nat Commun. 2016 Oct 10;7:12948. doi: 10.1038/ncomms12948.
• Martens CR, Denman BA, Mazzo MR, Armstrong ML, Reisdorph N, McQueen MB, Chonchol M, Seals DR. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nat Commun. 2018 Mar 29;9(1):1286. doi: 10.1038/s41467-018-03421-7.
• Chen AC, Martin AJ, Choy B, Fernandez-Penas P, Dalziell RA, McKenzie CA, Scolyer RA, Dhillon HM, Vardy JL, Kricker A, St George G, Chinniah N, Halliday GM, Damian DL. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention. N Engl J Med. 2015 Oct 22;373(17):1618-26. doi: 10.1056/NEJMoa1506197.
• Bai S, Sheline CT. NAD(+) maintenance attenuates light induced photoreceptor degeneration. Exp Eye Res. 2013 Mar;108:76-83. doi: 10.1016/j.exer.2012.12.007. Epub 2012 Dec 26.
• Zhang X, Henneman NF, Girardot PE, Sellers JT, Chrenek MA, Li Y, Wang J, Brenner C, Nickerson JM, Boatright JH. Systemic Treatment With Nicotinamide Riboside Is Protective in a Mouse Model of Light-Induced Retinal Degeneration. Invest Ophthalmol Vis Sci. 2020 Aug 3;61(10):47. doi: 10.1167/iovs.61.10.47.

Study record dates

Study Major Dates

• Study Start (Actual): September 19, 2025
• Primary Completion (Estimated): October 30, 2027
• Study Completion (Estimated): March 30, 2028

Study Registration Dates

• First Submitted: September 5, 2024
• First Submitted That Met QC Criteria: September 5, 2024
• First Posted (Actual): September 19, 2024

Study Record Updates

• Last Update Posted (Actual): March 23, 2026
• Last Update Submitted That Met QC Criteria: March 19, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Vitrectomy; Nicotinamide Riboside; Retinal detachment; Photoreceptors; Macula-off
• Additional Relevant MeSH Terms: Eye Diseases; Retinal Diseases; Retinal Detachment; Surgical Procedures, Operative; Ophthalmologic Surgical Procedures; Vitrectomy; nicotinamide-beta-riboside
• Other Study ID Numbers: NOMAD; U1111-1307-8530 (Other Identifier: Universal Trial Number, World Health Organisation)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes