cbd oil for ocular hypertension

How Medical Marijuana Treats Glaucoma

Cristian Zanartu, MD, is board-certified in internal medicine. He works at a cancer center in New York, focusing on pain and palliative medicine, and has a primary care practice with an emphasis on LGBT care.

Many people are wondering about the possible use of marijuana instead of eye drops to treat glaucoma. Glaucoma is a disease of the optic nerve, the nerve cable that connects the eye to the brain. Glaucoma can cause significant vision loss and even blindness. Most types of glaucoma coexist with high pressure inside the eye. Limited research has shown that marijuana could potentially treat glaucoma because of its ability to lower the pressure in the eye.

Traditional Treatments

An eye doctor's main goal in the treatment of glaucoma is to lower eye pressure to a safe level in order to halt damage caused by the high-pressure levels. Treatment typically includes prescribing medications, using laser treatments, or surgery.  

Most glaucoma patients are treated with topical medication eye drops that lower the pressure in the eye to a level where the glaucoma does not progress. Unfortunately, some people do not tolerate daily eye drops very well and additional glaucoma therapies are sought.

Marijuana's Effect on Glaucoma

As several more states attempt to legalize the use of marijuana for medicinal uses, it has become a hot topic for glaucoma patients as some studies have shown that smoking marijuana can lower eye pressure, both generally and in people that suffer from glaucoma. People who cannot tolerate typical glaucoma medications might be able to use marijuana to effectively lower their eye pressure.  

Downsides of Smoking Marijuana

Scientists have found that marijuana does lower eye pressure but the effects only last for 3 or 4 hours. This means that to lower eye pressure adequately, marijuana would have to be smoked every 3 hours.

Because marijuana causes mood-altering effects, smoking it every 3-4 hours would be impossible for people who drive for a living, operate heavy machinery, or have jobs that require close attention to detail.

Also of great concern is that marijuana cigarettes contain chemical compounds that can damage the lungs similar to regular tobacco cigarette smoking. Studies also show that chronic use of marijuana can have unwanted and sometimes permanent effects on brain function.

Marijuana Eye Drops

If the harmful effects of marijuana are mainly caused by inhalation, could doctors administer the active ingredient, THC (tetrahydrocannabinol), in a different way? Scientists have conducted studies in which patients ingested THC through oral (by mouth) or sublingual (under the tongue) methods and also in topical eye drops.

Although oral or sublingual methods avoid lung problems, they have other unwanted side effects. Because glaucoma is a chronic disease, unwanted systemic side effects make THC a poor option for treatment.  

While eye drops sound like the most logical method of taking the drug, THC is not very water-soluble. As a result, it has been difficult to develop an eye drop with high enough concentrations of THC to be effective.

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Negative Effects

If oral THC could be tolerated, more long-term studies are needed to make sure that it will not worsen glaucoma. Research has shown that some glaucoma is worsened by a lack of proper blood flow to the optic nerve. Marijuana actually reduces blood pressure so it is possible that marijuana could worsen the glaucoma by making the optic nerve receive less blood flow.

On the other hand, recent research shows that marijuana may not only treat glaucoma by reducing eye pressure, but it may also act on certain receptors to provide a type of neuro-protection against damage to the optic nerve. This would treat glaucoma in a different way, and it is worth conducting further studies.

Until then, researchers are focusing on a better way to make a THC formulation that people can tolerate and that will have a longer duration of action. For now, glaucoma patients should stick with doctor recommended traditional glaucoma medications.

Should You Be Using Marijuana to Treat Your Glaucoma?

As marijuana use becomes more accepted and increasingly legalized, glaucoma patients have questions about its effectiveness as a viable treatment option.

Marijuana has been legalized for medical use in 30 US states and for recreational use in 9 US States. It is classified by the federal Drug Enforcement Agency as a Schedule I controlled substance (the same category as heroin and LSD ). Nevertheless, perceptions and attitudes regarding marijuana use continue to evolve, with increasing interest in its therapeutic potential.

Ability to Lower Intraocular Pressure

Marijuana’s ability to lower intraocular pressure (IOP) was discovered in the 1970s. Elevated IOP is the major risk factor for glaucoma and lowering IOP is currently the only treatment. Doctors and scientists have wondered whether marijuana could be used as a therapy to lower IOP and prevent the progression of glaucoma. Glaucoma patients also are interested to know whether marijuana can be used to treat glaucoma.

While marijuana does lower IOP, it has major drawbacks as a treatment for a chronic, long-term, disease like glaucoma. First, in contrast to conventional glaucoma eyedrops (some of which are effective for up to 24 hours), smoking THC reduces eye pressure for only 3-4 hours. To control IOP would require 8-10 doses of marijuana per day. This would not only cost more than typical glaucoma treatment, but the physical and mental side-effects of frequent marijuana use would prevent functioning productively. For example, while users may enjoy its euphoric effects, marijuana also impairs judgment and coordination, increases paranoia, elevates heart rate, and irritates the eyes.

Long-term Safety Concerns

Concerns also exist regarding the long-term safety of marijuana use, due to its associations with permanent lung damage when smoked, and possible permanent adverse effects on cognition and mental health. With regular use, tolerance to the eye pressure-lowering effects develops, meaning that increasing drug levels would be required to prevent progression of glaucoma. Finally, lack of regulation and quality control makes efficacy and safety of marijuana unpredictable. Research efforts to develop THC eyedrops that can effectively lower eye pressure while minimizing side effects are underway but have not yet been successful.

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For these reasons, while marijuana does lower eye pressure, it is not recommended as a medical treatment for glaucoma. If you use marijuana, let your eye doctor know since it may have an impact on your eye pressure readings. Also, it is very important to continue your current glaucoma therapy and regular monitoring as recommended by your eye doctor.

Article by Kathryn E. Bollinger, MD and Kevin M. Halenda, MD.

Kathryn E. Bollinger, MD is a glaucoma specialist and Associate Professor of Ophthalmology within the Medical College of Georgia at Augusta University. Her research focuses on development of novel neuroprotective treatments for glaucoma.

Kevin M. Halenda, MD is a second-year ophthalmology resident at the Medical College of Georgia at Augusta University. He is a graduate of Emory University School of Medicine and Princeton University.

Effect of sublingual application of cannabinoids on intraocular pressure: A pilot study

Purpose: The purpose of this study was to assess the effect on intraocular pressure (IOP) and the safety and tolerability of oromucosal administration of a low dose of delta-9-tetra-hydrocannabinol (Delta-9-THC) and cannabidiol (CBD).
Patients and Methods: A randomized, double-masked, placebo-controlled, 4 way crossover study was conducted at a single center, using cannabis-based medicinal extract of Delta-9-THC and CBD. Six patients with ocular hypertension or early primary open angle glaucoma received a single sublingual dose at 8 AM Of 5mg Delta-9-THC, 20mg CBD, 40mg CBD, or placebo. Main outcome measure was IOP. Secondary outcomes included visual acuity, vital signs, and psychotropic effects.
Results: Two hours after sublingual administration of 5mg Delta-9-THC, the IOP was significantly lower than after placebo (23.5 mm Hg vs. 27.3 mm Hg, P = 0.026). The IOP returned to baseline level after the 4-hour IOP measurement. CBD administration did not reduce the IOP at any time. However, the higher dose of CBD (40 mg) produced a transient elevation of IOP at 4 hours after administration, from 23.2 to 25.9 mm Hg (P = 0.028). Vital signs and visual acuity were not significantly changed. One patient experienced a transient and mild paniclike reaction after Delta-9-THC administration.
Conclusions: A single 5 mg sublingual dose of Delta-9-THC reduced the IOP temporarily and was well tolerated by most patients. Sublingual administration of 20 mg CBD did not reduce IOP, whereas 40mg CBD produced a transient increase IOP rise.

Keywords

  • delta-9-tetrahydrocannabinol
  • cannabidiol
  • glaucoma
  • IOP
  • ocular toxicity
  • messenger RNA
  • receptor CB1
  • Delta-9-tetrahydrocannabinol
  • neurotoxicity
  • involvement
  • injury
  • eye

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In: Journal of Glaucoma , Vol. 15, No. 5, 10.2006, p. 349-353.

Research output : Contribution to journal › Article

T1 – Effect of sublingual application of cannabinoids on intraocular pressure

T2 – A pilot study

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AU – Tomida, Ileana

AU – Azuara-Blanco, Augusto

AU – House, Heather

AU – Flint, Maggie

AU – Pertwee, Roger Guy

AU – Robson, Philip J.

N2 – Purpose: The purpose of this study was to assess the effect on intraocular pressure (IOP) and the safety and tolerability of oromucosal administration of a low dose of delta-9-tetra-hydrocannabinol (Delta-9-THC) and cannabidiol (CBD). Patients and Methods: A randomized, double-masked, placebo-controlled, 4 way crossover study was conducted at a single center, using cannabis-based medicinal extract of Delta-9-THC and CBD. Six patients with ocular hypertension or early primary open angle glaucoma received a single sublingual dose at 8 AM Of 5mg Delta-9-THC, 20mg CBD, 40mg CBD, or placebo. Main outcome measure was IOP. Secondary outcomes included visual acuity, vital signs, and psychotropic effects. Results: Two hours after sublingual administration of 5mg Delta-9-THC, the IOP was significantly lower than after placebo (23.5 mm Hg vs. 27.3 mm Hg, P = 0.026). The IOP returned to baseline level after the 4-hour IOP measurement. CBD administration did not reduce the IOP at any time. However, the higher dose of CBD (40 mg) produced a transient elevation of IOP at 4 hours after administration, from 23.2 to 25.9 mm Hg (P = 0.028). Vital signs and visual acuity were not significantly changed. One patient experienced a transient and mild paniclike reaction after Delta-9-THC administration. Conclusions: A single 5 mg sublingual dose of Delta-9-THC reduced the IOP temporarily and was well tolerated by most patients. Sublingual administration of 20 mg CBD did not reduce IOP, whereas 40mg CBD produced a transient increase IOP rise.

AB – Purpose: The purpose of this study was to assess the effect on intraocular pressure (IOP) and the safety and tolerability of oromucosal administration of a low dose of delta-9-tetra-hydrocannabinol (Delta-9-THC) and cannabidiol (CBD). Patients and Methods: A randomized, double-masked, placebo-controlled, 4 way crossover study was conducted at a single center, using cannabis-based medicinal extract of Delta-9-THC and CBD. Six patients with ocular hypertension or early primary open angle glaucoma received a single sublingual dose at 8 AM Of 5mg Delta-9-THC, 20mg CBD, 40mg CBD, or placebo. Main outcome measure was IOP. Secondary outcomes included visual acuity, vital signs, and psychotropic effects. Results: Two hours after sublingual administration of 5mg Delta-9-THC, the IOP was significantly lower than after placebo (23.5 mm Hg vs. 27.3 mm Hg, P = 0.026). The IOP returned to baseline level after the 4-hour IOP measurement. CBD administration did not reduce the IOP at any time. However, the higher dose of CBD (40 mg) produced a transient elevation of IOP at 4 hours after administration, from 23.2 to 25.9 mm Hg (P = 0.028). Vital signs and visual acuity were not significantly changed. One patient experienced a transient and mild paniclike reaction after Delta-9-THC administration. Conclusions: A single 5 mg sublingual dose of Delta-9-THC reduced the IOP temporarily and was well tolerated by most patients. Sublingual administration of 20 mg CBD did not reduce IOP, whereas 40mg CBD produced a transient increase IOP rise.