Despite AGS stance, some specialists say marijuana has role in glaucoma treatment
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As medical marijuana becomes increasingly legal in the U.S., eye care providers are fielding more inquiries and making decisions about its use in the treatment of glaucoma, according to a study published in the Journal of Glaucoma.
“The current stance of the [American Glaucoma Society (AGS)], [American Academy of Ophthalmology (AAO)] and [Canadian Ophthalmological Society (COS)] is that marijuana is not an acceptable treatment for glaucoma,” Zachary Bergman, MD, MPH, of the department of ophthalmology and visual sciences at the University of Maryland School of Medicine, and colleagues wrote. “However, with increasing access to marijuana, both for medical and recreational purposes, there has been increasing interest amongst patients with glaucoma about the potential role of [medical marijuana (MMJ)] in the management of their disease.”
Bergman and colleagues sent an electronic survey to members of the AGS to evaluate glaucoma specialists’ perceptions and attitudes about MMJ in the treatment of glaucoma. Questions included practitioner demographics, previous experience discussing MMJ use, prescribing patterns and knowledge of MMJ in glaucoma management.
Of 198 respondents, 74% said they practiced in states where MMJ is currently legal, 27% practiced in states where MMJ is currently illegal, and 4% were unsure of marijuana legalization status in their state. Thirty-seven percent had patients who reported MMJ use for their glaucoma, and 78% of respondents were asked at least monthly about MMJ; more than half of respondents had patients ask for medical marijuana prescriptions. In addition, 14% of respondents kept information about MMJ in their office.
Further, 76% of respondents expressed interest in receiving additional education on the topic, and 27% answered that there is a role for MMJ in the management of glaucoma, despite the AGS stance on its use.
“With expanding legality of MMJ in the United States, it is important for ophthalmologists to have greater understanding of the implications of MMJ and glaucoma treatment and how it can impact their patients,” Bergman and colleagues wrote.
Perspective
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Experts have rejected the use of MMJ as a therapeutic option in glaucoma care, yet patient inquiries regarding the use of MMJ are probably one of the most common questions I get. I respond that drugs with the least invasive route and systemic interactions are preferred. In plain language, I explain that too much of the drug would be needed for even a questionable therapeutic effect. Of course, patients inevitably joke that they would be willing to take the risk.
Yes, the public has inaccurate ideas about MMJ, but many experts in this study didn’t know which route of THC or which cannabinoids (or delivery route) are most effective in decreasing IOP. A lesser known but very important danger is that CBD has the potential to increase IOP. The concentration of THC in medical marijuana has increased tenfold since the IOP-lowering research was done in the 1980s (from 2.0% to up to 22% today). Its route of consumption has also changed since that time.
Doctors should warn glaucoma patients regarding the use of CBD products, particularly those with aggressive disease. In the future, marijuana or related substances may be used in glaucoma therapy. For now, patients must be counseled on the dangers of adopting unproven or potentially harmful therapies.
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