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What do CBD, cannabis, and marijuana have do with with optometric care? Find out. CBD is a chemical found in marijuana that is considered medicinal, and it has been advertised as a treatment for many issues, including glaucoma. Learn why CBD does not actually work well for eye treatment. Epic 404 – Article Not Found This is embarassing. We can’t find what you were looking for. Whatever you were looking for was not found, but maybe try looking again or search using the form

Cannabis and CBD oil: a new “old” friend in optometry

Optometric training requires learning about bones, muscles, neurology, and the vascular and other systems. But have you heard of the endocannabinoid system (ECS)?

If the answer is no, that’s not surprising.

Although the ECS is critical for human survival, 1,2 cannabinoid receptors weren’t identified until 1964, 1-4 when investigators were trying to locate where marijuana tetrahydrocannabinol (THC) interacted with the brain. It wasn’t until 1988 that the ECS was identified, and 1992 when it was officially acknowledged. 2-4

Humans operate on the parasympathetic and sympathetic system. The parasympathetic system operates under “normal” conditions.
When the body perceives it is under attack, neurochemicals trigger the sympathetic system, activating the “fight or flight” response. 5,6

The ECS, simply put, disengages the sympathetic system. It is responsible for bringing the body back into balance (homeostasis). 2,7 If it doesn’t, the body is faced with unresolved “danger” from the chemicals and processes that are designed to protect it. These chemicals cause inflammation and begin attacking and damaging the body, 7,8,9 which is then labeled as “such and such” disease. Our rampant, epidemic health problems are self-inflicted, 5,7,10 brought on by our diet, lifestyle, and technology. 7,10,11

The ECS (Figure 1) is made up of 2 main receptor sites, CB1 and CB2. 2,4,7,10

CB1 sites are primarily in the brain, heart, and lungs, and modulate the immune response. CB2 receptors are primarily located in the lymph system, detoxification organs, and peripheral systems to break down and clear out the toxic immune system chemicals and debris. 1,3,7,14,24

The body produces its own chemical—anandamide, known as the bliss chemical—to regulate our systems via the ECS. 7,13,14 Unfortunately, in today’s high-stress environment, it can’t create enough to keep up with the demand. 10,14

Eating dark chocolate, exercising, or being “in the zone” are other ways to feed the CB1 and CB2 receptors. 7,14 Cannabidiol (CBD) was removed from livestock feed when it was made schedule 1 in 1941, so it has not been in the food chain for 80 years. CBD is nature’s external equivalent to supplementing the body’s anandamide shortage. 17,18,24


Cannabis

Technically, cannabis is not marijuana; nor is CBD. Cannabis is the botanical name for the common hemp plant, which has been cultivated for industrial purposes for more than 20,000 years. 15,18,24

The medicinal properties of hemp have been utilized for over 10,000 years. 15 The 2 main classes of cannabis are sativa, which is generally stimulating, and indica, which is generally calming. 16,18

Marijuana is a small subset of hemp that has been bred to produce more “high.” Hemp has over 400 different chemicals, with 100 compounds known as cannabinoids, each creating various effects. 16,18

CBD is one of the most prevalent cannabinoids in the hemp plant; it has the most profound, diverse, and beneficial impact. 16,18 The main takeaway is that cannabis is really just the hemp plant, and CBD is not marijuana.


THC

THC and CBD originate from the same compound and have nearly identical chemical structures (Figure 2). 16,22 Depending on the genetic strain, the hemp will have higher or lower THC and CBD levels. When the flower is beginning to bloom, however, growers must test the plants daily because the CBD in the plant will start to become THC. 16,22

At that point, the growers only have 48 hours to harvest their crop. The legal amount for THC to not be considered marijuana is 0.3%. 19,22

The CBD industry wants as high an amount of CBD as possible with the least THC possible. CBD’s profound effects on all bodily functions are not forced—unlike those of pharmaceutical agents—and nor does the chemical have their toxicities or unintended adverse effects (Figure 3). 20,21,24

As of February 2022, 37 states in the United States have legalized marijuana for medical use and 18 have legalized it for recreational purposes .20 The medical and recreational marijuana market is projected to be $30 billion in 2022. 21

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Although marijuana still has legal hurdles to overcome, the CBD market is legal in all 50 states. 22 CBD is also available OTC and thus is free from FDA regulations and red tape. 22 The CBD market is projected to be $2 billion in 2022. 23

This projection will result in both good and bad consequences. Because cannabis has been outlawed as a Schedule 1 drug for 80 years, little controlled research has been undertaken and no distinction made between the effects of THC and those of CBD.

Medical benefits, risks

Much of marijuana use is for the high it produces, but there are some documented medical benefits. These include the relief of pain and nausea related to cancer treatments, aiding of sleep issues, reduction of posttraumatic stress disorder symptoms, easing of symptoms in those withdrawing from opioid addiction, and a calming of symptoms of various neurological conditions. 4,24

Unfortunately, according to more recent findings, marijuana does interfere with cognitive ability, 24,29 damages memory function, and destroys brain tissue. It also causes heart attacks—even in younger people with no underlying conditions—may have negative effects on genetics and pregnancy, and, if ingested by vaping or smoking, increases cancer risks. 24 Thus, marijuana is far from risk free.

Vision effects

Of more direct concern to optometrists are the negative effects of marijuana on the visual system. Both photopic and scotopic vision are impaired due to decreased macular and peripheral sensitivity. 24-35

Neurologically, vision processing is compromised, creating selective scotomas and interfering with one’s ability to navigate in the environment. 24,26-28,30,32-35

The eye is both a specialized neurologic receptor and a person’s primary connection to the physical world. It is important for optometrists to be aware of CBD, as eyes are packed with both CB1 and CB2 receptors.

Consider the major 5 medical conditions optometrists often encounter with when working with patients:

1. Cataracts 37

2. Glaucoma 38,39

3. Macular degeneration 41-43

4. Allergies 46

5. Meibomian gland disease 47

Although each is a separate condition, all have inflammation as the root cause due to the eye being threatened by the environment. 35,40 Many treatments are based on treating the symptoms or slowing the progression of damage by interfering with the ocular response process.

CBD works with the body’s natural system to decrease the inflammation process and restore homeostasis, avoiding the long-term results that define disease.

Peer-reviewed, evidence-based science is limited. However, I have heard anecdotally that some patients have experienced better vision with OTC supplementation of CBD and ocular nutraceuticals, backed by macular pigment ocular density (MPOD), optical coherence tomography (OCT), retinal photographs, and acuity. 43,44


Looking ahead

We have accepted that ocular “aging” conditions are normal, inevitable, and unstoppable. 45,57 Perhaps traditional medical treatments would be less necessary if we worked with the natural body system designed to minimize those issues.

Beyond ocular conditions, optometrists must step back and look at the larger medical issues facing humanity.

Obesity, diabetes, blood pressure, heart disease, cancer, Alzheimer disease/dementia, autoimmune conditions (lupus), rheumatoid arthritis, fibromyalgia, multiple sclerosis, neurologic disorders, depression, anxiety, panic attacks, migraines, attention-deficit/hyperactivity disorder, and concussions are all inflammation-related processes caused by an increased assault on our physical system.

This has overloaded the natural mechanism eyecare professionals were designed with to maintain health. Optometrists need to learn about ECS and CBD to augment their toolbox for taking care of patients’ well-being. 6,9,36,48,51,55,56,59-63

CBD & the Eyes: Research & Can It Help You?

NVISION® content is medically reviewed by a licensed Ophthalmologist, Optometrist, Surgeon or Doctor. These vision experts ensure the content is fact-based and up-to-date.

We have strict sourcing guidelines and every page contains a full list of references for transparency.

CBD has become a touted treatment for various issues, including glaucoma. This is based on older medical studies and anecdotal reports that CBD oil, eye drops, and other forms of medical marijuana help to ease anxiety, eye strain, and eye pressure.

One of the first studies on medical marijuana for eye conditions involved glaucoma. This is a group of serious eye disorders associated with damage to the optic nerve, usually due to high fluid pressure in the eye, or intraocular pressure (IOP). This pressure must be lowered to prevent blindness. Further studies of medical marijuana have found that the drug does not actually lower pressure for long enough.

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The United States Food and Drug Administration (FDA) has approved CBD for some very limited medical uses, and several states have legalized both medical and recreational use of marijuana, both THC and CBD.

Dispensaries recommend CBD for eye treatment, especially glaucoma. Medical research has found that medical marijuana does not lower eye pressure for more than three or four hours, which is not long enough to prevent damage to the optic nerve. Paradoxically, it may increase the risk of damage due to fluctuations in eye pressure over the course of the day.

In fact, a recent medical study found that THC, not CBD, lowered eye pressure. By itself, CBD raises IOP, and in combination with THC, it can prevent THC from lowering IOP. THC is the intoxicating, recreational chemical in marijuana, which can be addictive and cause problems with thinking or memory.

It is important for you to follow medical advice from your optometrist and ophthalmologist to manage all eye conditions, from dry eyes to glaucoma. Don’t attempt to self-treat any eye issue with CBD.

Table of Contents

Cannabidiol (CBD) & Your Eyes: High Intraocular Pressure Is Dangerous

Glaucoma is a group of related eye conditions involving damage to the retina and optic nerve that leads to vision loss, typically due to high fluid pressure inside the eyes. Symptoms tend to start slowly until enough of the optic nerve is damaged that the person develops tunnel vision or another form of lost vision. Regular eye exams can help to diagnose glaucoma or high ocular pressure, so an optometrist or ophthalmologist can monitor this progression and ensure you receive appropriate treatment if you begin to lose your sight.

Treating glaucoma starts with medicated eye drops that are designed to lower intraocular pressure. If these do not work, there are several approaches to surgery that can lower fluid pressure in the eyes and prevent vision loss.

There are side effects to all these options, so many people with glaucoma, or who are at risk for glaucoma, want to find alternatives. One proposed alternative is CBD oil, or the cannabidiol molecule derived from medical marijuana.

Using Medical Marijuana Like CBD for Your Eyes Does Not Work

As marijuana has become more popular and many states have legalized both medical and recreational uses for this drug, CBD oil is being promoted for a range of uses, including as a glaucoma treatment.

There are very few medical studies on the effectiveness of CBD or medical marijuana, although the United States Food and Drug Administration (FDA) has information on potentially beneficial uses for this approach to treatment. They have approved one CBD-based drug for two types of severe, rare epilepsy. Some forms of medical marijuana have been examined to treat eye conditions, especially glaucoma, but newer research suggests that CBD is not an effective treatment for your eyes.

Medical marijuana has been touted to generally ease physical and emotional pain, including nausea related to cancer treatment, chronic pain, general anxiety disorder, and other conditions. In the 1970s and 1980s, medical marijuana was studied as an eye treatment, particularly for serious conditions like cataracts and glaucoma, which can lead to blindness. The research found that marijuana could lower intraocular pressure for three or four hours at a time, and it was more effective at lowering pressure in the eyes than glaucoma drops.

However, the studies also found that these pressure-lowering effects would wear off after a certain amount of time, while the effects of glaucoma eye drop treatment lasted at least 12 hours. It is vital for eye health that treatment to manage intraocular pressure lasts for a long time and is consistent. When eye pressure rises and lowers several times throughout the day, damage to the optic nerve can get worse.

Medical Studies on CBD & the Eyes Suggests CBD Is a Dangerous Chemical

CBD in particular is receiving a lot of attention from the medical community and medical marijuana proponents. However, studies suggest that the CBD compound may make intraocular pressure higher, while THC (tetrahydrocannabinol), the chemical in marijuana associated with substance abuse and getting high, is responsible for lowering eye pressure.

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A study conducted in 2018 found that THC and CBD regulate eye pressure differently. When they are separated from marijuana, they will have radically different effects.

The results of the 2018 study found that a single dose of THC drops lowered IOP by 28 percent for 8 hours in male mice, although humans with glaucoma need 24-hour pressure relief to reduce damage to the optic nerve. The study also found two interesting problems. First, CBD inhibited THC from lowering IOP. Second, the effects of THC on eye pressure were sex-dependent, with male mice receiving noticeably greater benefit from the treatment.

  • Accelerated heartbeat, which can trigger anxiety or feel like anxiety.
  • Decreased blood pressure overall, which can be harmful to the cardiovascular system.
  • Reduced blood flow to several parts of the body, including the optic nerve, which can increase damage.
  • Increased risk of lung cancer specifically from smoking or vaping marijuana products.
  • Greater risk of addiction with any amount of marijuana treatment containing THC.
  • Drowsiness, memory loss, and cognitive issues associated with abusing marijuana.
  • Struggles to hold down a job or drive safely if drug-tested.

Most medical research suggests that CBD does not intoxicate you the same way THC does, but taking types of medical marijuana marketed as “high CBD” might mean there are traces of THC included in the substance. THC is addictive because it can change brain chemistry to make you feel relaxed, less anxious, sleepy, or even happy. The drug can also cause negative side effects like changes in mood, spikes in anxiety or paranoia, delusions, and trouble thinking or problem-solving.

Follow Your Eye Doctor’s Treatment Plan for Treating Eye Conditions

Some dispensaries hype CBD for the eyes aside from glaucoma treatment, suggesting that it can ease pain from surgery, reduce dry eye, and even alleviate eye strain. However, there are no medical studies to back up these claims. The changes to eye pressure due to CBD may lead to damage to your vision, even if you do not have glaucoma.

The only currently approved medical approach for glaucoma is regular eye exams to monitor the condition. Follow your eye doctor’s advice to manage this condition if you are diagnosed with it. This will likely mean eye drops first to prevent vision loss. It could also mean laser eye surgery, drainage devices, or other types of surgery to alleviate intraocular pressure and reduce damage to the optic nerve.

References

Glaucoma. (July 2020). National Eye Institute (NEI).

Cannabidiol (CBD) – What We Know and What We Don’t. (August 2018). Harvard Health Publishing, Harvard Medical School.

Is There a Risk of Blindness With CBD? (2018). United States Food and Drug Administration (FDA).

CBD Oil May Worsen Glaucoma. (February 2019). American Academy of Ophthalmology (AAO).

What Is Marijuana? (December 2019). National Institute on Drug Abuse (NIDA).

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