Cbd oil benefits for macular degeneration
by Vanessa Caceres
EyeWorld Contributing Writer
Many ophthalmologists have fielded questions about marijuana use and eye health, particularly if they are in a state where medical marijuana is legal.
Now, expect to get questions about a specific component of cannabis that’s growing in popularity.
Cannabidiol, or CBD, is a chemical found in the cannabis plant. It does not make users “high,” and it has been used by many as an oil or infused into food, skin creams, and even gummies.
Under the 2018 Agriculture Act, hemp and CBD were made legal in all 50 states, although some in the medical field say there still is confusion over the specifics. Nonetheless, this has helped to set off a brigade of products and companies touting the health benefits of CBD. “This recent legislature significantly lightened the restrictions in industrial hemp, paving the way for CBD,” said Samantha Morrison.
Outside of the world of eyes, some researchers and patients have found some specific benefits for CBD. “Researchers have found that CBD has proven anti-inflammatory, antioxidant, anti-aging, and neuroprotective properties,” Ms. Morrison said. “As a result, more and more people are turning to the organic compound for treating a wide variety of ailments, including inflammation, anxiety, pain, nausea, and even neurologic disorders.”
“CBD and other cannabinoids have nice results in the reduction of anxiety and chronic pain. It is the workhorse of the cannabinoids. CBD is what does the work on reducing muscle spasms, pain, and inflammation,” said Mary Clifton, MD, who provides cannabis consultations in New York and through her virtual telemedicine portal.
In clinical trials, CBD has been shown to be an effective treatment for epilepsy, according to a report from the World Health Organization. 1 Last year, the U.S. FDA approved Epidiolex (GW Pharmaceuticals), a CBD-based drug designed to treat two rare and severe forms of epilepsy. Other CBD-based drugs are under development, including Arvisol (Echo Pharmaceuticals), which is in pre-clinical testing for epilepsy and schizophrenia.
On the consumer level, CBD users are reporting that they have found relief from sleep problems, inflammation, and stress and anxiety, according to Brenda Green, MEd. There are also many who purchase CBD oil for pet anxiety or inflammation, she added. Some parents are trying CBD for attention deficit disorder in their children.
The use of CBD is most effective as a tincture (placed under the tongue) or vaped, although some consumers dislike the idea of using a vape, Ms. Green said. Jordan Tishler, MD, cautions that research on CBD dosing has shown that you cannot vape enough to get an effective treatment.
Cannabidiol has few side effects. Some studies have noted fatigue, diarrhea, and change in appetite, but these are considered rare, Ms. Morrison said.
For the eyes
Ophthalmologists may wonder how all this comes back to eye health. Because marijuana has had a long-time association with glaucoma (even if scientific evidence does not back it), medical professionals and patients tend to ponder whether CBD also can improve eye health, be it for glaucoma or other ocular issues.
The bottom line: The evidence is mixed, and it’s likely too early for a clear answer.
A 2016 Canadian study of CB1 and CB2 receptors in monkeys concluded that manipulating the endocannabinoid system may help restore normal vision and protect the retina. 2
“In practice, cannabinoids help regulate the arterial tone within blood vessels in the central nervous system. This has led researchers to study the effect of cannabis on retina ischemia and retinopathy in general,” Ms. Morrison said. “Clinical trials indicate that cannabinoid receptor antagonists may inhibit cellular degeneration caused by the release of lactate dehydrogenase induced by retinal ischemia.”
A U.K. study that reviewed research on cannabinoids and glaucoma reported that because CBD has antioxidant properties not mediated by the CB1 receptor, it could prevent neuronal death by scavenging toxic reactive oxygen species produced by overstimulation of receptors for glutamic acid. 3 “Perhaps the potent antioxidant properties of the cannabinoids may be beneficial in [age-related macular degeneration], offering a possible alternative to established antioxidant supplements,” the authors wrote.
“Some publications have suggested that cannabinoids can be neuroprotective, so that has some implications for retinal diseases like retinitis pigmentosa. The results are mixed, and I would say contradictory,” said Alex Straiker, PhD.
A recently published study that received attention in the consumer press focused on both CBD and Δ9-tetrahydrocannabinol (THC, the main psychoactive ingredient in cannabis) and their role in regulating IOP. 4 “Over the last several years, we have determined that three different cannabinoid receptors—CB1, GPR18, and GPR119—each can lower pressure in mice when activated. Once this was established, it made sense to go back to THC and CBD to see how they act,” said Dr. Straiker, one of the study’s co-researchers. Their study provided topical application of both THC and CBD in mice, and researchers found the CBD actually raised IOP. At the same time, THC lowered IOP through a combination of CB1 and GPR18 receptors. The effect of THC was sex-dependent, with longer effects in male mice. Additionally, CBD canceled out the IOP-lowering effects of THC, probably by blocking CB1 receptors, Dr. Straiker said.
Between research and practice, for now, there is no CBD treatment recommended specifically for the eyes. “It is not an effective treatment for any ophthalmologic issues,” Dr. Tishler said. “Further, the high doses needed to see any result in illness are not achievable in eyecare.”
In her own review of the research, Dr. Clifton sees potential for CBD and certain eye health issues. “It makes sense that taken internally, it would help inflammation or pain syndromes affecting the eye, just like it does any tissue,” Dr. Clifton said. She perceived several of the previous studies conducted as biased against cannabis.
Research on CBD in the U.S. likely will expand now that it is no longer classified as a Schedule 1 drug, Mr. DeRose said (marijuana is still on the Schedule 1 list from the Drug Enforcement Act). One of many questions that could be explored with further research is what happens in subjects who smoke high-CBD varieties of cannabis, Dr. Straiker said.
Ophthalmologists can use their growing knowledge of CBD to guide patient queries appropriately, particularly in states where marijuana has been legal for a longer length of time.
“CBD is a very common topic of ongoing education throughout Colorado,” said Antonio DeRose. “This has helped reduce negative stigma and spread positive awareness for several medicinal properties, which in turn is leading more people to turn to CBD over certain prescriptions and over-the-counter medications.” However, Dr. Tishler said that this can be dangerous if done without regard to a patient’s actual medical care.
“At true treatment doses of 10–20 mg/kg, CBD can interact with conventional medications and depending on what those are, can be quite dangerous,” Dr. Tishler said.
Ophthalmologist Ray Chan, MD, receives one or two questions a month about CBD or marijuana, mostly from patients who have a stronger interest in alternative medicine. If patients are using CBD for systemic health, he advises checking with their primary care doctor to find out if it’s helpful. If it’s for eye health, “I would advise them that there is no scientific evidence that it helps the eye. There are many better and cheaper medications to treat glaucoma,” he said.
Dr. Tishler is asked frequently about CBD for sleep and pain relief, but he states the data only supports the use of THC/THC-dominant whole flower for these problems.
For those who want to delve deeper into CBD use, it’s important to learn more about dosing. Ms. Green advises CBD users to start “low and slow” but also noted that it’s easy to get the dosing wrong, which is why users should buy from retailers with extensive product knowledge. Product quality is also key. There are a lot of CBD products entering the market, but that does not necessarily mean they are all effective, Ms. Green said.
Dr. Clifton also recommends tinctures or vaping and steers patients away from edibles, which can take longer to be effective.
Marijuana use for glaucoma not effective
Although there’s a common perception that marijuana can help lower IOP, that is not a formal recommendation from ophthalmologists.
“We have known since 1971 that smoking marijuana does lower your eye pressure, which is the main treatment for glaucoma. However, the eye pressure lowering effect is very short acting,” Dr. Chan said. For someone to achieve a sustained IOP lowering, they need to constantly use the drug, which could lead to systemic changes to the brain, lungs, and cardiovascular system, he explained.
Cannabis for glaucoma “is entirely impractical and dangerous,” Dr. Tishler said.
In a 2014 paper, the American Academy of Ophthalmology said there is no evidence that marijuana provides an increased benefit for or diminished risk of glaucoma compared to the traditional treatments available. 5
About the sources
Ray Chan, MD
Texas Health Arlington
Mary Clifton, MD
Internal medicine physician
Antonio DeRose, NASM CPT
Green House Healthy
Brenda Green, MEd CBD specialist
Alex Straiker, PhD
Senior research scientist
Department of Psychological and Brain Sciences
Jordan Tishler, MD
President, Association of Cannabis Specialists
Harvard Medical School
- World Health Organization. Cannabidiol: Pre-review report. November 2017. www.who.int/medicines/access/controlled-substances/5.2_CBD.pdf
- Bouskila J, et al. Cannabinoid receptors CB1 and CB2 modulate the electroretinographic waves in vervet monkeys. Neural Plast. 2016;2016;1253245.
- Tomida I, et al. Cannabinoids and glaucoma. Br J Ophthlamol. 2004;88:708–13.
- Miller S, et al. Δ9-tetrahydrocannabinol and cannabidiol differentially regulate intraocular pressure. Invest Ophthalmol Vis Sci. 2018;59:5904–5911.
- AAO Complementary Therapy Task Force, Hoskins Center for Quality Eye Care. Marijuana in the Treatment of Glaucoma CTA – 2014. June 2014. www.aao.org/complimentary-therapy-assessment/marijuana-in-treatment-of-glaucoma-cta–may-2003
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CBD For Macular Degeneration—What to Know
It’s a widely reported fact that the human eye can see about 10 million colors. Rod and cone cells located within our retina enable light and depth perception as well as that differentiation of color. While glaucoma and cataracts are eye conditions that have become household terms, there’s another disease that’s far more prevalent. Affecting more than 10 million Americans of all ages—more than glaucoma and cataracts combined—macular degeneration is the leading cause of vision loss.
With no known cure, many people battling this disease will often turn to injections, supplements, and lifestyle changes like diet and exercise to preserve their vision. Meanwhile, others have turned to Cannabidiol (CBD) and to help slow down the effects of macular degeneration, despite scientific proof that CBD may help.
What is macular degeneration?
To say that the eye is one of the most awe-inspiring organs in our bodies simply doesn’t do it justice. It’s also one of the most complex, so when you find a good analogy that helps explain how it works, it’s something to latch on to.
The American Macular Degeneration Foundation (AMDF) compares the eye to a camera and the macula the central part of the eye’s “film.” When functioning properly, AMDF says, that macula gathers images at the center of the field of vision and transfers them to the brain via the optic nerve.
The analogy is somewhat outdated today, but what used to happen to film that experienced breakdown or degradation? Haze? Blur? Spots? All of the above?
When the eye’s film—the cells within the macula—deteriorates, the brain fails to receive those images correctly. Known as macular degeneration, this regression can worsen and result in blurry vision. In severe cases, sufferers will lose their central vision, leaving only their peripheral vision and robbing them of the ability to read a book, drive a car, or even recognize the faces of loved ones.
Types of macular degeneration
There are essentially two types of macular degeneration—wet and dry—though nearly 90% of cases will fall into the dry category. For this type, the macula degrades due to an accumulation of small, yellow deposits of debris called drusen. The presence of this drusen is what causes the macula to thin and dry, leading to a loss or reduction in vision.
Conversely, wet macular degeneration occurs when abnormal blood vessels take shape under the retina. As they grow, those vessels begin to bleed and seep into the macula, warping and distorting the person’s vision.
Stages of macular degeneration
The prevalence of macular degeneration is a scary concept to grasp when you consider that most people will collect drusen in their retina as they age. But a slight buildup of drusen is quite normal and not a cause for concern—it’s only when there are large deposits that macular degeneration begins to occur.
What’s known as early macular degeneration is consistent with medium-sized drusen, but because the disease is still in its infancy, vision loss does not occur.
However, we do start to have at least some reduction in vision with intermediate macular degeneration. Large drusen deposits occur in this stage, yet someone may not be able to perceive or notice the change in vision quite yet.
Once the condition progresses to late macular degeneration, daily functioning becomes affected, and vision loss is easily noticeable.
How and why CBD may benefit macular degeneration sufferers
A 1971 research study on glaucoma, published in the Journal of the American Medical Association (JAMA), found that many of the study’s participants experienced a 30% reduction in eye pressure after smoking marijuana. That type of success in a research trial led some to consider cannabis an alternative modality for treating the symptoms of glaucoma. It has also resulted in patients asking their doctors about using cannabis for other eye conditions like macular degeneration.
Because of its rise in popularity, coupled with the fact that it’s legal to buy and use throughout the country—unlike marijuana—CBD has become a popular topic of conversation for those suffering from these types of ailments.
As with most items related to CBD, there’s either a lack of evidence proving its merits in eye health or a mixed bag of studies.
One particular Canadian study from 2016 did find that by manipulating the endocannabinoid system (ECS) in monkeys, it may be possible to protect the retina and restore normal vision. As a reminder, CBD influences the ECS by binding with the CB2 receptors in the immune system. Since it is non-toxic, there’s no reason for users to fear getting high like they would with THC.
In a 2004 study from the United Kingdom, researchers examined the antioxidant properties of cannabinoids like CBD and how those properties might have an impact on eye health.
“Other possible applications of cannabinoids in ophthalmology could be explored,” the researchers wrote. “Age related macular degeneration (AMD) is the leading cause of blindness in the United Kingdom. Perhaps the potent antioxidant properties of the cannabinoids may be beneficial in AMD, offering a possible alternative to established antioxidant supplements.”
The study went on to point out that cannabinoids can slow the onset of Vascular Endothelial Growth Factor, or VEGF, which is a contributor to macular degeneration. A cancer research study indicated that cannabinoids significantly lowered VEGF activity in lab mice and two patients with late-stage glioblastoma, a severe type of brain cancer.
Each of these studies gives hope that CBD could be a viable option for treating macular degeneration, but it’s too early to tell.
Final words on CBD for macular degeneration
Earlier this year, the American Academy of Ophthalmology reported that CBD oil may worsen glaucoma. While that report didn’t touch specifically on CBD for macular degeneration, it does underscore the reality that we’re still learning about how and why CBD works in our bodies.
The potential of using CBD for macular degeneration is exciting—especially when legitimate research studies are illustrating exactly how it could attack the disease—but you should always consult with your physician before dosing CBD to address any symptoms.