The Truth About The Use of Medical Marijuana for the Treatment Of Glaucoma.

Due to the growing legalization of medical marijuana debates, there have raised many questions over the uses of Marijuana for the treatment of Glaucoma. It has also caused many patients who use marijuana for recreational use to talk to their ophthalmologist about their own prevention of glaucoma.

First, we have to understand the background….

In terms of treatment of glaucoma, a patient MUST have 24 hour coverage of eye pressure lowering effects. Basically, if a patient were to have Glaucoma, and they were to use an eye drop that lowers the eye pressure for only 8 hours, that means that the patient is still walking around with elevated eye pressure for 16 hours during the day. That is not only poor coverage, but it is actually MORE dangerous than not treating it at all. You see, under-treating eye pressure causes even greater fluctuations in eye pressure than had it been left alone. This is extremely dangerous for Glaucoma patients.

What is Glaucoma? Glaucoma is an eye disease that causes progressive, painless visual loss, which if goes undetected, will lead to total blindness. It is the #2 cause of irreversible blindness in the USA. There are many risk factors which can lead to or even worsen Glaucoma, however the most popular risk factor is an elevated eye pressure. This is why billions of dollars or research has lead to multiple surgical procedures and countless medications, which are aimed strictly to lower eye pressure.
What is Marijuana? Marijuana is a natural plant that grows in the ground. It has multiple medicinal/recreational uses which are derived from 2 active ingredients in Marijuana. Active Ingredient #1- THC (tetrahydrocannabinol) THC is the portion of the Marijuana plant that causes euphoria, or “getting high” sensation, slowed reflexes, increasing hunger, and in some instances hallucinations. Active Ingredient #2- CBD (cannabidiol) CBD causes relaxation, and pain relief

How has Marijuana been linked to Glaucoma? In 1971, a study came out showing that marijuana lowers the eye pressure. After this study, marijuana has been labeled as the natural miracle plant for treatment of glaucoma. The only problem is, the study never stated which active ingredient lowered the pressure, and it also did not state how long the effect would last.
Now that you have the background, lets tackle the newest study done at the University of Indiana in 2018. They tested the effects of each one of ingredients (THC and CBD) on eye pressure when used alone, as well as when used together. What they found was astonishing, but shocking.

They tested an eyedrop with CBD, the component of cannabis that does not get you stoned, and they found that it RAISED EYE PRESSURE by 18 percent for at least four hours after the drops were instilled. They also tested THC, the component that does get you stoned, and they found that drops containing only THC decreased eye pressure by up to 30 percent within eight hours. They then tested an eye drop with BOTH CBD and THC and found that due to the counteracting effects of CBD vs THC, marijuana does lower eye pressure, but for a very short amount of time.

What does this mean? This means that although CBD has many medicinal positive effects, it should be used in extreme caution! Patients with Glaucoma should NOT use CBD as it will likely increase the patient’s eye pressure. If used for an extended period of time, it can lead to glaucoma in patients at risk, who normally would not have developed glaucoma.

While it’s true that smoking marijuana can reduce pressure inside the eye, it remains a suboptimal treatment because people with glaucoma require 24-hour pressure control to prevent vision loss. You would need to smoke marijuana 8 to 12 times a day, every single day of your life; a treatment regimen that would make it difficult to hold down a job, drive, or function, not to mention the potential cost. The potency of marijuana also varies considerably. It is also unknown yet how it interacts with other medications. One study showed that some people can build up a tolerance to marijuana’s eye pressure lowering effects.

This is the reason why the American Academy of Ophthalmology and the American Glaucoma Society do not recommend using marijuana for treatment of Glaucoma. However, these studies released by the University of Indiana have had eye opening detrimental effects of CBD on eye pressure. CBD is readily available, legally, at pharmacies and the internet without prescriptions, but please use it in caution and speak to your eye doctor about whether the benefits you are seeking from CBD can be used safely with YOUR eye status. YOUR eye is not the same as your friend, parent or sibling’s eye, so please don’t use what an eye doctor tells your friend/parent/sibling and assume it pertains to you too.

Learning About Eye Conditions With Help From Disney Characters

Learning About Eye Conditions With Help From Disney Characters

Very often eye doctors get asked certain questions repeatedly. Also, many patients or parents of patients look online for answers to common eye questions, or searching for a diagnosis. As an ophthalmologist, I find it very easy to educate patients on their conditions with visual aids. As a huge Disney fan, I decided to recruit a few of my favorite Disney characters to assist me. So, if you like Disney and want to learn a bit about eyes, here we go!

COMMON   EYE    CONDITIONS:

Lewis from Meet The Robinsons

Lewis from Meet The Robinsons

 

MYOPIA:

Here is Lewis, from the Disney Movie “Meet The Robinsons.” He has a light case case of myopia, or otherwise known as ‘near-sightedness.’ He, like many people can not see far without glasses, but can see at near. Typically, near-sighted patients wear their glasses all day long to help visualization for daily living.

 

 

 

 

 

 

Edna Mode - The Incredibles

Edna Mode – The Incredibles

 

HYPEROPIA:

Here we have Edna Mode from Disney/Pixar’s “The Incredibles.” She has a severe case of hyperopia, or far-sightedness. Unfortunately, far-sightedness is a misnomer. Most commonly, people think it means that the person can see far, but not near, however that is incorrect. Far-sighted patients needs glasses not only to see far, but also to see near. If Edna were to remove her glasses, she would probably be blind as a bat.

 

 

Geppetto- Pinnoccio

Geppetto- Pinnoccio

 

PRESBYOPIA:

Often occurring with age, Presbyopia usually develops around the age of 40 years old. Due to the increased difficulty at near, patients with presbyopia need glasses to assist in near-vision. Therefore, this is why most people at the ago of 40 years old (or so) start to need reading glasses. As you can see, Geppetto does not need glasses for distance, but he does need it for near-vision and reading.

 

 

Alice - Alice in Wonderland

Alice – Alice in Wonderland

 

EPIPHORA (Tearing):

Epiphora, or unexplained tearing, is a very common condition. There are many causes, including allergies, dry eyes, foreign bodies, and block tear-drainage systems. In this photo, Alice is obviously over-acting, but this is to teach people about how severe it can become. Most cases are not this bad.

 

 

 

Cruella De Vil

Cruella De Vil- 101 Dalmations

 

CONJUNCTIVITIS:

There are many causes of red eyes. Often, conjunctivitis is assumed to be infectious, however, it can also be allergic, seasonal, due to chemicals and other causes. The most common causes are Viral (aka PINK EYE) which is contagious and easily treated, Bacterial which is more rare and often contact lens related, and allergic.

 

Dopey - Snow White & The Seven Dwarfs

Dopey – Snow White & The Seven Dwarfs

 

CONTACT LENSES

Here we have one of the seven dwarfs, Dopey, showing off his new contact lenses. These old-school contact lenses are never recommended, because you can end up looking like Cruella in the above photo.

 

 

Hades- Hercules

Hades- Hercules

 

DRY EYES:

Hades is also over-acting when portraying the condition of dry eyes, however, it does paint a common picture. Patients with dry eyes often exhibit red eyes that burn and often feel like they are on fire. This can be quite irritating and often severely painful.

 

Crush - Finding Nemo

Crush – Finding Nemo

 

PTOSIS: (pronounced ‘toe-sis’)

Crush unfortunately has a more severe case of ptosis, which is “drooping eyelids.” Usually it affects one eye, therefore making patients think they have a smaller eyeball, when in reality they have one eyelid that droops. In Crush’s case, he has it in both eyelids, which is much more common in the elderly, due to muscle eyelid weakness. Of course, we would expect that with Crush because he is 150 years old (and still young, dude).

 

Big Baby- Toy Story 3

Big Baby- Toy Story 3

 

CONGENITAL PTOSIS:

Congenital Ptosis is a drooping eyelid in a child that occurs either from birth or develops at a very young age. Although thought to be a cosmetic problem, it can sometimes be sight-threatening in some cases and should be evaluated immediately once detected to prevent permanent visual loss. Big Baby needs an ophthalmologist, STAT!

 

Nick Fury- The Avengers

Nick Fury- The Avengers

 

OCULAR TRAUMA:

Although Nick Fury is a character from Marvel, Marvel was bought by Disney, therefore after Mr. Fury begged me to put him in this post, now I can. Ocular trauma unfortunately is a common problem. Remember when your parents said “don’t to that, you can poke someone’s eye out?” Well, I’ve seen it. Ask Mr. Fury!

 

Yao- Mulan

Yao- Mulan

 

EYELID HEMATOMA:

A hematoma is the medical term for a ‘black & Blue mark.’ Of course it can occur on any part of the body, but Yao happened to get one on his eyelid. Sometimes, they can become so large, that they close the eyelids shut, until the black & blue mark disappears. The most common cause is obviously trauma, but can occur with valsalvas, blood thinners, ocular surgery, Botox injections, and some blood clotting disorders.

 

 

Olaf - Frozen

Olaf – Frozen

 

PROSTHETIC EYE:

In this picture, Olaf is showing of his new, magical prosthetic eye. Although it does help him see, in humans, they don’t.

 

 

LESS COMMON EYE CONDITIONS:

Gurgle- Finding Nemo

Gurgle- Finding Nemo

 

THYROID EYE DISEASE:

Gurgle, unfortunately has a condition called Graves Disease. This disease is when a person has an overactive thyroid. One of the signs of this disease is eyelid retraction. When the upper eyelid retracts upward, it makes the eyes look larger than they really are and have a “bulging” appearance.

 

 

 

 

 

Roger Rabbit

Roger Rabbit

 

SEVERE THYROID OPHTHALMICUS:

Although Roger does not really have thyroid eye disease, he is able to make his eyes bulge as if he really did. Roger is just showing off right now, but in severe thyroid eye disease, the eyes truly do bulge out of the socket and are often frozen and can not move. Sometimes the eyes are pushed so far out, that the eyelids can not close and the eyes can dry out. This is an ocular emergency and can require surgery to fix.

 

Darla- Finding Nemo

Darla- Finding Nemo

 

ESOTROPIA (aka ‘inward-turned eye’)

Darla, unfortunately has a condition that is pretty common in children and should be referred to an ophthalmologist right away. It can often be cured with either glasses, patching or surgery, but must be detected early in life to have a good chance of success from treatment.

 

 

Genie- Aladdin

Genie- Aladdin

 

ACCOMMODATIVE ESOTROPIA:

Genie is exhibiting a condition where a person displays inturning eye(s), or esotropia, only when looking at near objects. This is often treated with glasses.

 

 

 

Genie- Aladdin

Genie- Aladdin

 

EXOTROPIA (Out-turning eye(s)):

Here, Genie is showing us a severe example where both eyes are turned out at the same time. This is usually not the case. Most likely, a patient will only have one eye that turns out, or they will have either eye turn out, but not at the same time. Once again, this must be detected early in age to have success to treat.

 

 

 

 

 

Doc - Snow White & The Seven Dwarfs

Doc – Snow White & The Seven Dwarfs

 

HYPERTROPIA (up-turned eye):

I asked Doc to help out a little. He said he can show us one eye turning up, while the other looks straight. This is a very rare condition. Thanks Doc!

 

 

Billy Bones- Treasure Planet

Billy Bones- Treasure Planet

 

ECTROPION (out-turned eyelids):

Mr. Bones has very irritated eyes, because of his ectropion of both lower eyelids. If you look at his eyelids, you will see they are drooping outwards, away from his eyeballs. This causes a space where the eyelids do not touch the eyeballs causing severe dryness and irritation. This is usually treated with surgery.

 

Anchor- Finding Nemo

Anchor- Finding Nemo

 

HYPERTELORISM:

Anchor was born with a rare congenital ocular disorder called HYPERTELORISM. It is a condition where the eyes are spaced very far apart from each other. This is usually associated with other facial and skull deformities, just like Anchor has.

 

 

 

Beast- Beauty & The Beast

Beast- Beauty & The Beast

 

BLEPHAROSPASM:

In this photo, Beast is suffering from Blepharospasm. This is an uncontrolled forceful blink that can be short or last a few seconds. Often associated with allergies or tics, it can can also occur for other reasons. In adults this can be treated with Botox, which is why Beast looks like a handsome prince at the end of the movie (spoiler-alert).

Gaston- Beauty & The Beast

Gaston- Beauty & The Beast

 

7th CRANIAL NERVE PALSY / BELLS PALSY:

Although no one acts like Gaston or spits like Gaston, he is suffering from a common problem. In this condition, the Facial Nerve, which is the nerve that controls movement of half of your face, can stop working. This will cause one eye not to be able to close (aka Bells Palsy), and sometimes occur with a down-turned lips on one side (aka Complete 7th Nerve Palsy). This is often treated with ocular lubricants and resolves on it own within 6 weeks-4 months.

 

Horned King- Black Couldron

Horned King- Black Cauldron

 

ANOPHTHALMOUS:

The Horned King was born with no eyeballs. Anophthalmous is a congenital birth defect where a baby is born without an eyeball, or rarely no eyeballs at all. Luckily this is rare and has no cure to date.

 

 

Mike Wazowski

Mike Wazowski

CYCLOPIA:

Mr. Wazowski is the worlds most popular cyclops. Born with one central eye. In humans, though, the one central eye usually does not see and this condition is usually associated with multiple facial abnormalities. Babies born with Cyclopia, usually have so many congenital abnormalities that they usually do not survive. Luckily for us, Mr. Wazowski did survive, despite not being born with a nose or second eye, and has been making us all laugh since 2001. Mr. Wazowski now works in Tomorrowland, DisneyWorld, where he works on the Laugh Floor Comedy Factory.

Cheshire Cat- Alice In Wonderland

Cheshire Cat- Alice In Wonderland

 

JAUNDICE:

Cheshire Cat, unfortunately has a case of jaundice, which is a yellowing of the skin and eyeballs. Although it is hard to see on Cheshire’s skin, his eyes are exhibiting the classic yellow appearance seen in jaundice. This is usually a sign of liver disease and once detected, a liver workup should be ordered immediately. This can also occur in babies, after birth. This occurs when bilirubin builds up in the blood. Babies with jaundice should be sent to the pediatrician immediately.

 

 

Patch- 101 Dalmatians 2

Patch- 101 Dalmatians 2

 

NEVUS OF OTA:

Patch was born with this birth defect called Nevus of Ota. A Nevus is a medical term for a freckle. In this case, it is a large darkening of the skin of the eyelids and periorbital area on one side of the face. Although a cosmetic defect, it is sometimes associated with Glaucoma in the eye surrounded by the nevus, therefore requiring close follow-up with an ophthalmologist.

 

 

 

 

Rumpelstiltskin- Once Upon A Time

Rumpelstiltskin- Once Upon A Time

 

WILSON’S DISEASE:

Although this condition is usually considered hematologic, due to excess copper build-up in the blood, it does have classic eye findings. Despite the copper-like skin, a small ring of copper develops on the cornea (called a Kayser-Fleischer Ring) and slowly gets larger with time. Once treated, the copper-corneal ring disappears.

 

 

Aliens- Toy Story

Aliens- Toy Story

 

TRICLOPIA:

Not yet seen in humans!

 

 

 

 

I hope you enjoyed our demonstration, and if you have any Disney Characters that have other ocular conditions that need diagnosis, please post it here or ask away and I will be sure to come up with a diagnosis. Just make sure your Disney character has insurance. ENJOY!