IOP monitoring in patients using CBD

Classifying cannabidiol, or CBD, as a food additive may have serious long-term consequences for the visual system. It raises eye pressure, and we all know that high eye pressure leads to blindness.

CBD is the non-psychoactive ingredient found in marijuana and hemp. Animal studies (Miller et al.) and humans (Tomida et al.) show that CBD, even in modest doses, raises IOP, so food containing CBD is potentially dangerous to eye health.

Among those states with legal medical marijuana, the majority agree to use marijuana to treat glaucoma (Valenti). The psychoactive cannabinoid, tetrahydrocannabinol (THC), has been shown to lower IOP. However, eye care providers do not recommend the use of marijuana to treat glaucoma, as more effective interventions are available.

Dennis A Valente

Israel, a country that has been at the forefront of marijuana and cannabis research, does not include glaucoma on its list of diseases approved for marijuana use. There are limited studies regarding intraocular pressure lowering effects, and even fewer include actual glaucoma patients.

Unfortunately, many eye care providers are not aware of the negative side effects of elevated CBD IOP despite high-quality animal research showing this dangerous finding. More research is needed on the human response to CBD.

No research was done on the visual system prior to the Food and Drug Administration’s approval of a pure CBD product, Epidiolex (Greenwich Biosciences) For use in severe epilepsy. The committee that voted to approve Epidiolex recognized potential liver toxicity as a side effect but felt such complications could be controlled.

The panel did not discuss the high IOP concerns that have been demonstrated in both the human and animal model or how to manage them. No warnings are included on the website that provides information to doctors and the general public.

Optometrists owe their patients the best quality care and work to preserve their eyesight. This includes a discussion of marijuana products such as THC and CBD and involves managing the patient with CBD as a patient at high risk of developing glaucoma.

Benefits of using CBD has been shownHowever, patients using this agent should be carefully monitored for ocular effects. I will consider cyclic and diurnal measurements of IOP. Hopefully, doctors will eventually have enough information to answer patients’ questions about it.

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Denise A. Valenti, O.D., Reports being the founder and president of IMMAD LLC – Impairment Measurement and Marijuana, a company that provides services, consulting and technology development for the responsible use of cannabis. She has over 3 decades of experience working with patients with sensory impairment, cognitive impairment, vision and age-related changes as well as driving experience. She can be contacted at deniseavalenti@gmail.com.

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