Tag Archives: Glaucoma

Indiana University study: CBD in marijuana may worsen glaucoma, raise eye pressure

7 Jan

The National Institute on Drug Abuse reported in How might cannabinoids be useful as medicine?

Currently, the two main cannabinoids from the marijuana plant that are of medical interest are THC and CBD.
THC can increase appetite and reduce nausea. THC may also decrease pain, inflammation (swelling and redness), and muscle control problems.Unlike THC, CBD is a cannabinoid that doesn’t make people “high.” These drugs aren’t popular for recreational use because they aren’t intoxicating. It may be useful in reducing pain and inflammation, controlling epileptic seizures, and possibly even treating mental illness and addictions. Many researchers, including those funded by the National Institutes of Health (NIH), are continuing to explore the possible uses of THC, CBD, and other cannabinoids for medical treatment.
For instance, recent animal studies have shown that marijuana extracts may help kill certain cancer cells and reduce the size of others. Evidence from one cell culture study with rodents suggests that purified extracts from whole-plant marijuana can slow the growth of cancer cells from one of the most serious types of brain tumors. Research in mice showed that treatment with purified extracts of THC and CBD, when used with radiation, increased the cancer-killing effects of the radiation….10
https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine

There is a question among medical providers about marijuana’s usefulness in glaucoma treatment.

David Turbert, contributing writer: Dayle Kern wrote in American Academy of Ophthalmology article which was reviewed by Dr. J. Kevin McKinney, MD, MPH, Does Marijuana Help Treat Glaucoma?

Medical marijuana is promoted as a treatment for many diseases, including glaucoma. And now that the sale and possession of marijuana has been legalized in states like Colorado and Washington, it can be easier than ever to self medicate as a glaucoma treatment without consulting your ophthalmologist. But does it really work?
Glaucoma is an eye condition in which the optic nerve becomes damaged over time, reducing side vision. It sometimes leads to blindness. One cause of optic nerve damage in glaucoma is higher-than-normal pressure within the eye (intraocular pressure or “IOP”).
Currently, the only way to control glaucoma and prevent vision loss is to lower your IOP levels. Your ophthalmologist can treat glaucoma with medication, such as prescription eye drops, or surgery, depending on the type of glaucoma and how severe it is.
Learn more about: Glaucoma treatment options
The idea that marijuana can be helpful in treating glaucoma dates to the 1970s. Studies conducted then showed that smoking marijuana lowered the IOP of people with glaucoma. As a result of this research, additional studies were conducted examining whether marijuana or its active ingredient, a compound known as THC, could be used to keep IOP lowered. This research was supported by the National Eye Institute, a division of the federal National Institutes of Health.
The research found that when marijuana is smoked or when a form of its active ingredient is taken as a pill or by injection, it does lower IOP. However, it only lowers IOP for a short period of time—about three or four hours.
This short period of time is a major drawback for the use of marijuana as a glaucoma treatment. Because glaucoma needs to be treated 24 hours a day, you would need to smoke marijuana six to eight times a day around the clock to receive the benefit of a consistently lowered IOP. Because of marijuana’s mood-altering effect, smoking so much of it daily would leave you too impaired to drive, operate equipment or function at the peak of your mental ability….
Scientists are still exploring whether the active ingredients in marijuana may yet offer a glaucoma treatment. However, such developments require much more research and are many years from becoming a reality.
So, while marijuana can temporarily lower your IOP, it’s not recommended for treating glaucoma. Prescription medication and surgical treatments have been tested and proven as effective treatments for the condition. On June 27, 2014, the American Academy of Ophthalmology reiterated its position that it does not recommend marijuana or other cannabis products for the treatment of glaucoma. https://www.aao.org/eye-health/tips-prevention/medical-marijuana-glaucoma-treament

An Indiana University study questioned the use of marijuana in the treatment of glaucoma.

Science Daily reported in CBD in marijuana may worsen glaucoma, raise eye pressure:

One of the most commonly proposed uses of medical marijuana is to treat glaucoma.
But a study from researchers at Indiana University has found that a major chemical component in the substance appears to worsen the primary underpinning of the disease: a rise in pressure inside the eye.
The chemical that causes this rise in pressure is cannabidiol, or CBD, a non-psychoactive ingredient in cannabis that is increasingly marketed to consumers in products such as oil, gummies, creams and health food. It is also approved in many states as a treatment for conditions such as pediatric epilepsy.
The study was reported Dec. 14 in the journal Investigative Ophthalmology & Visual Science….
The study, which was conducted in mice, specifically found that CBD caused an increase in pressure inside the eye of 18 percent for at least four hours after use.
Tetrahydrocannabinol, or THC, the primary psychoactive ingredient of marijuana, was found to effectively lower pressure in the eye, as has been previously reported. But the study found that the use of CBD in combination with THC blocked this effect.
Specifically, the study found that male mice experienced a drop in eye pressure of nearly 30 percent eight hours after exposure to THC alone. A lower pressure drop of 22 percent was also observed after four hours in male mice.
The effect was weaker in female mice. This group experienced a pressure drop of only 17 percent after four hours. No difference in eye pressure was measured after eight hours.
The results suggest that females may be less affected by THC, though it isn’t clear whether this extends to the substance’s psychoactive effects.
“This difference between males and females — and the fact that CBD seems to worsen eye pressure, the primary risk factor for glaucoma — are both important aspects of this study,” Straiker said. “It’s also notable that CBD appears to actively oppose the beneficial effects of THC.”
By comparing the effect of these substances on mice without specific neuroreceptors affected by THC and CBD, the IU researchers were also able to identify the two specific neuroreceptors — named CB1 and GPR18 — by which the first substance lowered pressure inside the eye.
“There were studies over 45 years ago that found evidence that THC lowers pressure inside the eye, but no one’s ever identified the specific neuroreceptors involved in the process until this study,” Straiker said. “These results could have important implications for future research on the use of cannabis as a therapy for intraocular pressure.” https://www.sciencedaily.com/releases/2018/12/181217151537.htm

Citation:

CBD in marijuana may worsen glaucoma, raise eye pressure
Research in mice suggests over-the-counter substance could possess unknown side effects
Date: December 17, 2018
Source: Indiana University
Summary:
A study has found that CBD — a major chemical component in marijuana — appears to increase pressure inside the eye of mice, suggesting the use of the substance in the treatment of glaucoma may actually worsen the condition.
Journal Reference:
Sally Miller, Laura Daily, Emma Leishman, Heather Bradshaw, Alex Straiker. Δ9-Tetrahydrocannabinol and Cannabidiol Differentially Regulate Intraocular Pressure. Investigative Opthalmology & Visual Science, 2018; 59 (15): 5904 DOI: 10.1167/iovs.18-24838

Here is the press release from Indiana University:

PUBLIC RELEASE: 17-DEC-2018
Study suggests CBD may worsen glaucoma, raise eye pressure
Research in mice suggests over-the-counter substance could possess unknown side effects
INDIANA UNIVERSITY
One of the most commonly proposed uses of medical marijuana is to treat glaucoma.
But a study from researchers at Indiana University has found that a major chemical component in the substance appears to worsen the primary underpinning of the disease: a rise in pressure inside the eye.
The chemical that causes this rise in pressure is cannabidiol, or CBD, a non-psychoactive ingredient in cannabis that is increasingly marketed to consumers in products such as oil, gummies, creams and health food. It is also approved in many states as a treatment for conditions such as pediatric epilepsy.
The study was reported Dec. 14 in the journal Investigative Ophthalmology & Visual Science.
“This study raises important questions about the relationship between the primary ingredients in cannabis and their effect on the eye,” said Alex Straiker, an associate scientist in the IU Bloomington College of Arts and Sciences’ Department of Psychological and Brain Sciences, who led the study. “It also suggests the need to understand more about the potential undesirable side effects of CBD, especially due to its use in children.”
The study, which was conducted in mice, specifically found that CBD caused an increase in pressure inside the eye of 18 percent for at least four hours after use.
Tetrahydrocannabinol, or THC, the primary psychoactive ingredient of marijuana, was found to effectively lower pressure in the eye, as has been previously reported. But the study found that the use of CBD in combination with THC blocked this effect.
Specifically, the study found that male mice experienced a drop in eye pressure of nearly 30 percent eight hours after exposure to THC alone. A lower pressure drop of 22 percent was also observed after four hours in male mice.
The effect was weaker in female mice. This group experienced a pressure drop of only 17 percent after four hours. No difference in eye pressure was measured after eight hours.
The results suggest that females may be less affected by THC, though it isn’t clear whether this extends to the substance’s psychoactive effects.
“This difference between males and females — and the fact that CBD seems to worsen eye pressure, the primary risk factor for glaucoma — are both important aspects of this study,” Straiker said. “It’s also notable that CBD appears to actively oppose the beneficial effects of THC.”
By comparing the effect of these substances on mice without specific neuroreceptors affected by THC and CBD, the IU researchers were also able to identify the two specific neuroreceptors — named CB1 and GPR18 — by which the first substance lowered pressure inside the eye.
“There were studies over 45 years ago that found evidence that THC lowers pressure inside the eye, but no one’s ever identified the specific neuroreceptors involved in the process until this study,” Straiker said. “These results could have important implications for future research on the use of cannabis as a therapy for intraocular pressure.”
###
Other IU authors on the paper included Heather Bradshaw, an associate professor in IU Bloomington Department of Psychological and Brain Sciences. The study was supported in part by the National Eye Institute.
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to

The Glaucoma Research Foundation discussed glaucoma treatment in Should You Be Using Marijuana to Treat Your Glaucoma?

According to the Glaucoma Research Foundation:

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.
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.

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.                                                                                                                   https://www.glaucoma.org/treatment/should-you-be-using-marijuana-to-treat-your-glaucoma.php

As with treatment for any medical condition, the advice of competent medical personnel must be consulted.

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