Tuesday, September 4, 2018

Cannabis and Glaucoma




Cannabis and Glaucoma



Glaucoma is a group of diseases that cause damage to the eye’s optic nerve, and can lead to loss of vision. Glaucoma is the leading cause of blindness, and one of the medical conditions most often cited as being effectively treated by medical cannabis. As early as the 1970s, researchers observed that cannabis use reduced intraocular pressure (IOP) linked to this neurological damage, although this reduction only lasts a few hours.

In 1978 The National Eye Institute (NEI) supported research into cannabis treatment. These resulting studies demonstrated that cannabinoids temporarily lower IOP when administered orally or inhaled. The patients who got the best results took lower doses than the others. Taking smaller doses of cannabis helped reduce unwanted psychoactive effects while relieving IOP at the same time.





How Cannabis helps Glaucoma

Glaucoma causes buildup of pressure in the aqueous humor that is thought to damage retinal nerve cells. Endocannabinoid receptors are located throughout the eye, including the retina, the cornea, and surrounding tissues. These receptors are also located within the trabecular meshwork that drains the liquid intraocular aqueous humor from the eye.

In 2016, evidence was found that cannabinoids can reduce IOP by engaging both the cb1 receptor in the eye and GPR18 cannabinoid receptor. Both receptors play a role in controlling intraocular pressure. The two most prevalent active compounds produced by cannabis cultivars are the cannabinoids THC and CBD, both of which provide neuroprotective benefits, while THC also reduces IOP.

Some preclinical data supports the application of these cannabinoids for neuroprotection, as this ability may slow the selective death of retinal ganglion cells, a mechanism that is directly linked to loss of vision in glaucoma patients.





Dosing Guidelines

When taking cannabis for glaucoma, you would want to look for a medicine that has THC and CBD. You can take oral medication by consuming cannabis with cannabis oil or cannabis butter. Taking the cannabis orally could help the relief to last longer. You can smoke or vape the cannabis for a fast, but short-term relief. Make sure the product has about an equal amount of CBD and THC.  it is best to take small doses, such as 2.5mg – 5mg of CBD:THC cannabis, 3 - 4 times throughout the day, with your last dose taken before 5pm

The ability of THC to reduce IOP often declines over treatment, indicating that other IOP-lowering medications must be used simultaneously with cannabis. Start with small doses and only increase the dosing size, a little bit at a time, when you feel comfortable to handle the effects of taking THC.

Talk to a trusted medical professional who has done the research on cannabis and worked with glaucoma patients and cannabis before. If your doctor does not know what cannabis can do, find a trusted professional who does! Cannabis is a wonderful medicine for many ailments, however some patients need to understand how to use it (especially with other medications) for the best effective treatment.


Information found from the book

Cannabis Pharmacy: The Practical Guide to Medical Marijuana

by Michael Backes, foreword by Andrew Weil, M.D.





Real Patient Stories

Here are a few examples from other articles who have tested the use of cannabis as a remedy.
"Marijuana and Glaucoma" NCBI article
"Glaucoma and Marijuana", by an Oregon Eye Specialist:
Leafly's article "Can CBD and THC in Cannabis Be Used for Glaucoma Treatment?"





Videos

Does Marijuana Cure Glaucoma? HowCast:


The Use of Marijuana in the Treatment of Glaucoma


Cannabis for Glaucoma is the Real Deal


Case of the Day: Marijuana Treats Glaucoma


082 Glaucoma Hope: My Vision and My New Cannabis Protocol




 

Scientific Research for Cannabis and Glaucoma

The following articles have been found from the site ProjectCBD.org. For more information on how cannabis can help heal go to https://www.projectcbd.org/guidance/conditions


Neuroprotective effect of (-)Delta9-tetrahydrocannabinol and cannabidiol in N-methyl-D-aspartate-induced retinal neurotoxicity: involvement of peroxynitrite.


In glaucoma, the increased release of glutamate is the major cause of retinal ganglion cell death. Cannabinoids have been demonstrated to protect neuron cultures from glutamate-induced death. In this study, we test the hypothesis that glutamate causes apoptosis of retinal neurons via the excessive formation of peroxynitrite, and that the neuroprotective effect of the psychotropic Delta9-tetrahydroxycannabinol (THC) or nonpsychotropic cannabidiol (CBD) is via the attenuation of this formation. Excitotoxicity of the retina was induced by intravitreal injection of N-methyl-D-aspartate (NMDA) in rats, which also received 4-hydroxy-2,2,6,6-tetramethylpiperidine-n-oxyl (TEMPOL,a superoxide dismutase-mimetic), N-omega-nitro-L-arginine methyl ester (L-NAME, a nitric oxide synthase inhibitor), THC, or CBD. Retinal neuron loss was determined by TDT-mediated dUTP nick-end labeling assay, inner retinal thickness, and quantification of the mRNAs of ganglion cell markers. NMDA induced a dose- and time-dependent accumulation of nitrite/nitrate, lipid peroxidation, and nitrotyrosine (foot print of peroxynitrite), and a dose-dependent apoptosis and loss of inner retinal neurons. Treatment with L-NAME or TEMPOL protected retinal neurons and confirmed the involvement of peroxynitrite in retinal neurotoxicity. The neuroprotection by THC and CBD was because of attenuation of peroxynitrite. The effect of THC was in part mediated by the cannabinoid receptor CB1. These results suggest the potential use of CBD as a novel topical therapy for the treatment of glaucoma.



Effect of sublingual application of cannabinoids on intraocular pressure: a pilot study.


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-tetrahydrocannabinol (Delta-9-THC) and cannabidiol (CBD).

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 5 mg Delta-9-THC, 20 mg CBD, 40 mg CBD, or placebo. Main outcome measure was IOP. Secondary outcomes included visual acuity, vital signs, and psychotropic effects.

Two hours after sublingual administration of 5 mg 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.

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 40 mg CBD produced a transient increase IOP rise.










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