Thursday, September 1, 2011

An Overview of Medical Marijuana for Glaucoma

By David Greene, MD, CEO


Glaucoma affects more than 60 million people worldwide and the second leading cause of blindness behind cataracts. Both marijuana and THC have been shown to lower intra-ocular pressure, which is a key contributor to glaucoma. One of the most well known uses for medical marijuana is glaucoma.

The most common form of glaucoma is called primary open angle glaucoma and represents a slowly progressive disorder that destroys cells in the retina and also degrades the optic nerve. A person's visual field gets constricted and eventually disappears. The patient goes blind.

Three identifiable risk factors have been identified for glaucoma. Age and race are two which are out of a person's control. The 3rd is increased intra-ocular pressure, which is potentially controllable.

Normal eye pressure occurs from eye shape maintained from fluid called aqueous humor. Fluid flow occurs between the front part of the eye and the back of the cornea. With increased pressure, the fluid's flow is restricted from the front of the eye, and pressure rises. This fluid is supposed to bring nutrients to the optic nerve.

Decreasing eye pressure does not necessarily guarantee prevention of glaucoma, but it is actually the only controllable risk factor, it is the one medications are used for.

The 2 ways medications decrease eye pressure are:

1) Reducing the making of aqueous fluid

2) Making is easier for the front eye fluid to flow out

A few surgery options exist which can hopefully achieve the same goal.

Several studies have shown the effects of marijuana and THC on reducing eye pressure. Whether the THC is smoked, inhaled, or eaten, eye pressure is reduced. Applying cannabinoids directly to the eye did not work however.

Research hasn't identified the basic science of how cannabinoids reduce eye pressure. They decrease pressure for approximately four hours. So that means it would need to be taken 4 to 8 times daily, whereas other medications are only necessary twice daily.

Marijuana's side effects, like its psychoactive effects, may be tough for the elderly. The heart may race and patients may get anxious. Since glaucoma is a progressive disease the IOP needs to be controlled continuously.

With the most recent medications being effective for IOP control, marijuana is not typically a first line treatment. It is usually less effective and more problematic than the latest meds. However, for a second or third line treatment, marijuana may be excellent.




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