Monitor IOP in patients using CBD

October 27, 2021

2 minutes to read

Source / Disclosures

Disclosures: Valenti is the founder and president of IMMAD LLC.

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The classification of cannabidiol, or CBD, as a food additive can have serious long-term consequences for the visual system. It elevates eye pressure, and we all know that sustained high IOP leads to blindness.

CBD is the non-psychoactive 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 foods containing CBD are potentially harmful to eye health.

Of the states where medicinal marijuana is legal, the majority approve the use of marijuana for glaucoma (Valenti). The psychoactive cannabinoid, tetrahydrocannabinol (THC), has been shown to lower IOP. However, eye care professionals do not recommend the use of marijuana to treat glaucoma because there are much more effective interventions.

Denise A. Valenti

Israel, a country that has been at the forefront of marijuana and cannabis research, does not include glaucoma in its list of diseases approved for marijuana use. There are limited studies on the lowering effects of IOP, let alone involving real patients with glaucoma.

Unfortunately, many eye care providers are unaware of the negative side effect of CBD-boosted IOP despite good animal research showing this serious consequence. More research on the human response to CBD is needed.

No research was done on the visual system prior to FDA approval of a pure CBD product, Epidiolex (Greenwich Biosciences) for use in severe epilepsy. The committee voting to approve Epidiolex recognized potential liver toxicity as a side effect, but felt that such complications could be managed.

The committee did not discuss the IOP elevation issues that had been demonstrated in both a human and animal model or how it should be managed. No disclaimer has been included on the website which provides information to clinicians and the general public.

Clinicians of optometrists owe it to 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 the management of a patient using CBD as a patient at significant risk for glaucoma.

The benefits of using CBD have been demonstrated, but patients using this agent should be carefully monitored for eye effects. I would consider periodic and daytime IOP measurements. It is hoped that clinicians will eventually have enough information to answer patients’ questions on this topic.

For more information:

Denise A. Valenti, DO, reports being the founder and president of IMMAD LLC – Disability Measurement and Marijuana, a company that provides services, advice and technology development for the responsible use of cannabis. She has over 3 decades of experience working with patients with sensory impairments, cognitive dysfunction, vision and age-related changes as well as driving experience. She can be contacted at [email protected]

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