Date Posted: July 20, 2026

Author/s: Carmelita R. Jocson, MD and Alobert Vergel A. Capati, MD

Background: Citicoline (cytidine diphosphate choline) is a neuroprotective agent that has been studied for its potential benefits in managing several neurodegenerative disorders, including primary open angle glaucoma (POAG). POAG is characterized as a chronic, gradually progressive optic neuropathy that leads to optic nerve deterioration and subsequent visual field loss. There are preliminary findings supporting the use of Citicoline as a supplementary treatment for glaucoma; however, there remains a significant gap in conclusive data regarding its impact on disease progression. While existing reviews have explored this topic, to the authors’ knowledge, this is the first systematic review with a meta-analysis specifically evaluating the effect of Citicoline on visual field parameters in POAG patients.

Objective: To summarize the existing evidence regarding the effect of Citicoline on visual field changes in POAG patients, comparing different administration routes (intramuscular, topical, oral) and assessing overall treatment effects.

Methods: A literature search was conducted across PubMed, EBSCO, ProQuest, PLOS, and BMC, identifying 169 studies. After screening and removing duplicates, six studies published between 2005 and 2020 were included. The systematic review was conducted by comparing and tabulating the results of the included studies. The Newcastle- Ottawa Quality Assessment Form for Cohort Studies and the Revised Cochrane Risk of Bias Tool were utilized to assess the risk of bias. The meta-analysis was performed using data from two studies with comparable methodologies. Calculations were done using the Review Manager version 5.4 software.

Results: Six studies consisting of a total of 294 participants were included in this report. The weighted mean length of the follow-up was 28 ± 23 months. The weighted mean age of the patients was 57± 11 years. This review showed a trend of improvement or minimal change in mean deviation (MD) among participants receiving Citicoline, with statistically significant improvement noted in long-term studies of oral Citicoline. Secondary outcomes were intraocular pressure, side effects, retinal nerve fiber layer thickness, ganglion cell complex thickness, pattern electroretinogram and visual evoked potential parameters, visual acuity, and central corneal thickness. Meta-analysis revealed that oral Citicoline treatment produced a marginal significant effect in MD at 12 months (mean difference 1.95, 95% CI: – 1.10 to 4.01, p=0.06) and a significant improvement at 24 months (mean difference 3.49, 95% CI: 2.58 to 4.40, p<0.00001) compared to the control group.

Conclusion: Citicoline appears to offer a modest benefit in improving or stabilizing visual field parameters in POAG patients, particularly with longer treatment durations of oral Citicoline. Moreover, this review highlights the favorable safety profile of all forms of Citicoline. However, variability in study designs and methodologies highlights the need for standardized protocols and further research to confirm these findings and evaluate long- term efficacy. This study contributes to the growing body of evidence indicating that Citicoline can play a significant role in neuroprotection in glaucoma.

Keywords: citicoline, cytidine diphosphate choline, visual field, glaucoma