Marijuana for Glaucoma a Bad Choice

Dr. Kisling Eye Diseases Leave a Comment

Marijuana use has drastically increased recently in areas like Colorado that have passed amendments legalizing the medicinal use for certain chronic conditions. Glaucoma is listed as one of the main reasons for obtaining a registry identification card under Colorado‘s amendment 20, allowing the holder to use and retain limited quantities of marijuana. Cities like Fort Collins have had to react to the rapid proliferation of medical marijuana dispensaries and the lack of regulation and planning that has subsequently occurred. Federal law does not recognize the legality of state medical marijuana laws and the enforcement is still in question, even as the dispensaries proliferate.

The approval of marijuana for the treatment of glaucoma is lacking in justification and is not an FDA endorsed treatment. Glaucoma is a disease where the visual nerve cells degenerate and result in blindness over time if left untreated. Increased pressure inside the eye and impaired blood circulation to the optic nerve are part of the cycle that damages eyesight.

Research on the medical use of marijuana started to appear in the 1970’s. It does lower eye pressures in about 2/3 of the subjects by about 25-30%. This is an acceptable range for glaucoma drugs that are in use today. Unfortunately, the effect only lasts 3-4 hours and is probably not a steady state lowering over the time period. Effective treatment would require smoking marijuana every 2-3 hours. Eye pressure often spikes up at night and it would require use every few hours all night. Lowering eye pressure does not always treat glaucoma and there is currently little evidence to support that the eye pressure reduction from marijuana use has an effect on vision preservation. It has been postulated that the active ingredients of marijuana may increase the outflow of fluid from the eye through it’s drainage system to achieve the lowering effect. Unfortunately, there are also some effects on lowering blood pressure and episodes of systemic hypotension (sudden lowering of the blood pressure when standing). Since compromised  blood flow to the optic nerve is a vital factor in glaucoma, there is the possibility it could worsen glaucoma even though the eye pressure has been lowered.

There are over 400 active components in marijuana with Delta9-tetrahydrocannabinol being the most studied component. Like any herbal medicine, the concentration of these components varies as does the effectively of the product provided by dispensaries. Inhalation is more effective than oral dosing and carries risks to the lungs and other body systems. Consuming adequate dosing by consumption every 2-3 hours would create a high health hazard to the body. Unfortunately, eye drop application of the active ingredients has not proven to be effective in lowering pressure. Eye side effects include a drastic increase in dry eyes, redness, and eye irritation. The inhalation properties may increase the risk of macular degeneration and cataracts.

The possibility of isolating the active ingredients and separating them from the euphoric effects do warrant further studies. The possibility of a topical preparation that is effective is being studied. Studies show a direct correlation between lower frequency of drug administration and patient compliance. Any medication that needs to be used more than four times per day is unlikely to be used correctly over a long period of time, and once or twice a day is today’s goal. Any viable preparation of a marijuana derivative treatment for glaucoma will need to meet these criteria. Until that day arrives, seek treatment from an eye doctor with traditional prescription eye medications and if desired, supplement that treatment with acceptable alternative medical care that will not cause damage and possibly end in blindness.

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