Monitor IOP in patients using CBD
The classification of cannabidiol, or CBD, as a food additive may have long-term serious consequences for the visual system. It elevates eye pressure, and we all know sustained elevated IOP results in blindness.
CBD is the nonpsychoactive ingredient found in marijuana and hemp. Animal (Miller et al.) and human (Tomida et al.) studies show that CBD, even at modest doses, elevates IOP, so food containing CBD is potentially dangerous for ocular health.
Of those states with legal medicinal marijuana, the majority approve of marijuana use for glaucoma (Valenti). The psychoactive cannabinoid, tetrahydrocannabinol (THC), has been shown to lower IOP. However, eye care providers do not recommend the use of marijuana to treat glaucoma, as there are much more effective interventions available.
Israel, a country that has been on the forefront of marijuana and cannabis research, does not include glaucoma in its list of approved diseases for use of marijuana. There are limited studies related to IOP-lowering effects, and even fewer involve actual glaucoma patients.
Unfortunately, many eye care providers are unaware of the negative side effect of CBD spiking IOP despite quality animal research showing this serious consequence. More research on the human response to CBD is needed.
There was no research done on the visual system prior to the FDA approval of a pure CBD product, Epidiolex (Greenwich Biosciences) for use in severe epilepsy. The committee voting to approve Epidiolex acknowledged potential liver toxicity as a side effect but felt that such complications could be managed.
The committee did not discuss the concerns of IOP elevation that had been demonstrated in both a human and animal model or how it should be managed. No warnings were included on the website that provides information to clinicians and the general public.
Optometric clinicians owe it their patients to provide the best quality care and to work to preserve their vision. This includes the discussion of marijuana products such as THC and CBD and includes managing a patient using CBD as a patient with significant risk for glaucoma.
Benefits of using CBD have been demonstrated, but patients using this agent should be carefully monitored for the ocular effects. I would consider periodic and diurnal measures of IOP. It is hoped that clinicians will eventually have enough information to answer patients’ questions on this topic.
For more information:
Denise A. Valenti, OD, reports being the founder and president of IMMAD LLC – Impairment Measurement and Marijuana, a company the provides services, consulting and development of technology for the responsible use of cannabis. She has more than 3 decades of experience working with patients with sensory impairment, cognitive dysfunction, vision and age-related changes as well as the driving experience. She can be contacted at deniseavalenti@gmail.com.
References:
- CBD oil may worsen glaucoma. https://www.aao.org/eye-health/news/cbd-oil-may-worsen-glaucoma. Published Feb. 5, 2019. Accessed Oct. 26, 2021.
- FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms. Published June 25, 2018. Accessed Oct. 26, 2021.
- Miller S, et al. Invest Ophthalmol Vis Sci. 2018;doi:10.1167/iovs.18-24838.
- Tomida I, et al. J Glaucoma. 2006;doi:10.1097/01.ijg.0000212260.04488.60.
- Valenti DA. Medical marijuana and glaucoma: The United States experience. Presented at: Association for Research in Vision and Ophthalmology. May 7-11, 2017; Baltimore, Maryland.
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