One of the most prominent cultural stereotypes regarding cannabis is that of a senior citizen using it for the psychoactive effect (to get “high”), but then humorously excusing their digression by claiming to be medicating to treat glaucoma. Despite the popular Hollywood meme, this ocular condition — which affected 60 million patients globally in 2010 and is projected to afflict 80 million by 2020 — gains true efficacy and relief from the introduction of cannabinoids and terpenes to one’s endocannabinoid system.
This ocular disease disproportionately affects women and Asians and often results in blindness due to the degradation of the retina and optic nerve that it causes. Glaucoma afflicts about 5.5 million new sufferers each year. It is a very serious and potentially painful disease that is believed to be inherited, is caused by disturbances to the Intraocular Pressure (IOP) of the eye, and is the second leading cause of blindness. IOP is the pressure created in the eye by the continual renewal of critical fluids.
There are two primary types of glaucoma: Acute angle-closure (also called “open-angle”) and chronic (“closed-angle”). Open-angle glaucoma involves a blockage to the fluid that drains from the front of the eyes, whereas the closed-angle variety comprises a gradual imbalance in the production and removal of fluid within the eye, with supply exceeding demand.
Many glaucoma patients, who typically show signs of the disease later in life, experiment with cannabis as a last resort. Often, this is only after traditional pharmaceutical treatments and surgical operations, have proven ineffective. The fact of the matter: The only way to treat glaucoma is to lower IOP, and an effective way to lower IOP — according to literally hundreds of anecdotal patient testimonies and volumes of research studies dating back 45 years — is to consume cannabis via smoking, vaporizing, eating, or sublingually as a tincture.
“For some patients who have failed lots of treatments, [cannabis] is the only thing that keeps them from going blind.”
Explained Dr. Sunil Aggarwal, MD, Ph.D.
Glaucoma typically strikes those over the age of 40 and is associated with seniors and retirees. While this profile fits the majority of sufferers, the disease can also afflict young adults, children, and even infants. Those most susceptible to the condition include people with a family history of glaucoma, those with existing poor vision, and diabetes patients.
The mechanism behind glaucoma involves the fluid that flows between two chambers in the eye, one anterior (in front) and the other posterior (behind). A trabecular mesh, an area of tissue located around the base of the cornea, controls the flow of fluid between these two chambers. In glaucoma patients, the flow of fluid between the chambers has become disrupted, which results in excessive pressure in the eye. This pressure, in turn, causes damage to the retina and optic nerve. In severe cases, this damage results in blindness.
It is helpful to understand this mechanism from a molecular level. It just so happens that the neurons controlling the trabecular mesh feature cannabinoid receptors, meaning that the mesh is hardwired to accept both endocannabinoids (those produced by the human body) and phytocannabinoids (those from a plant source, such as cannabis). Cannabinoids (and terpenes) travel through the ophthalmic artery to enter the eyes and begin reducing IOP by binding with these special receptors.
The symptoms of glaucoma include eye pain, visible halos around lights, blurred vision, excessive redness, and nausea and vomiting — all of which result from an imbalance in intraocular pressure. This dynamic emphasizes the role of cannabis in helping sustain homeostasis, or “balance,” in the human body. One study revealed that cannabis lowered IOP by 25 percent, but it lasted for only three to four hours.
This is a concern for physicians who warn that an effective cannabis dosing schedule is too frequent and disrupts the sleep of patients. Those who question this dynamic must recognize that treatments that last only two to four hours result in sleep disruption and sometimes insomnia. The onset of pain can wake patients and prevent them from returning to sleep — leading to a long list of other problems, including an inability to properly heal or deal with the condition.
Dr. Sunil Aggarwal, a strong proponent of medical cannabis for a variety of conditions, helped produce a video that tersely describes the mechanism of glaucoma and how cannabis helps reduce ocular pressure and prevent damage — and, ultimately, blindness. Cannabis therapy can result in preserving and even improving vision, while also decreasing pain.
Because conventional drugs typically carry a litany of negative side effects, cannabis is inherently superior to the majority of pharmaceutical drugs simply because it delivers few side effects, most of which are not even categorized as “negative” by medical professionals and clinicians. These include, but only with some strains of cannabis: Increased heart rate at onset, lethargy or sleepiness (especially after one to two hours), increased appetite (the “munchies”), and possibly chattiness and slight hyperactivity (primarily from sativa-dominant strains).
Despite an overwhelming amount of research dating back to the early 1970s, some of the most convincing evidence for the efficacy of cannabis for glaucoma is provided by patient testimonies. Dozens of additional statements regarding the effectiveness of cannabis for this disease are available via YouTube and the internet.
Robert Randall developed glaucoma in his teens and, as an adult in the 1970s living in Washington, D.C., found relief from growing and smoking his own cannabis. Although he died in 2001, Randall remains one of the most powerful examples of the efficacy of cannabis for glaucoma. His activism led to the creation of the Compassionate Investigational New Drug Study Program (IND), the controversial government program that, to this day, supplies a small (and continually dwindling) group of patients with low-grade cannabis grown on the University of Mississippi farm that has been managed by the National Institute on Drug Abuse since 1968.
In 1976, Randall successfully sued the federal government for suppressing research into cannabis and glaucoma. Because he won, his case established the legal precedence for the concept of medical necessity, the genesis of a legal framework for acknowledging the need for patient compassion in public policy. Despite being told by doctors at the age of 25 that he would be blind by his 30th birthday, Randall enjoyed his vision until his death in 2001, at the age of 53. According to Randall and many medical experts, he maintained his vision only because he was daring enough to defy doctors and consume cannabis to lower his IOP.
Randall, who shot to fame when he smoked cannabis on CNN’s Larry King Live in 1988, is a testament to the role of cannabis to help glaucoma sufferers who find no relief in traditional treatments. According to his widow, Alice: “Bob was treated on every conventional [pharmaceutical drug] that was available, and it was only through the addition of marijuana that his eye pressure was lowered to within the safe range.”
“I think the only thing surprising here is that a small group of unelected bureaucrats has so long resisted making marijuana medically available. Essentially, it comes down to almost a theologic argument: They want to pretend that marijuana is simply evil and I think we have to be more rational than that.” — Robert Randall, 1988
Elvy Musikka is a 72-year-old glaucoma sufferer, cannabis legalization advocate, and poster child for the efficacy of this plant. She went blind in one eye in 1988, about the same time that she was busted in Florida for growing four plants to treat her symptoms. Musikka is also a participant in the IND program begun by the legal actions of Randall. Despite several failed surgical operations, the use of cannabis medicine is, miraculously, slowly restoring her vision.
“Robert Randall…is my hero forever. He is the one that absolutely showed the federal government — through their own…system — that he needed marijuana that was being grown in Mississippi…. He was the very first that challenged and won….”
Musikka has been using cannabis medicinally since her early 30s when her doctor told her that, if she didn’t begin smoking cannabis, she would become blind. After having tried cannabis out of desperation, she said: “It was the most efficient thing I had ever used — 0f everything they tried on me. It didn’t have the horrible side effects of some of the pills they gave to me. [Those pills] took your potassium away and you only wanted to stare at the ceiling.”
Musikka has been honest about the depression she experienced after her second ocular surgery failed and she was facing the serious prospect of complete blindness. She has stated in repeated interviews how cannabis has helped her overcome this depression and anxiety and seek alternative treatments (such as more and different forms of cannabis). Musikka succinctly summarized her attitude toward cannabis prohibition:
“This is not an acceptable situation. This is a hideous prohibition that’s hurting us environmentally, constitutionally, and morally.”
A 1971 study entitled Marihuana Smoking and Intraocular Pressure reported that subjects who smoked cannabis reduced their IOP by 25-30 percent, but that the duration of this relief was only three to four hours. This means that patients treating themselves in this manner (by smoking or vaporizing) must medicate on a regular basis, with the prospect of sleep interruption. The study concluded that cannabis may be employed when conventional medicine fails to help patients who otherwise are out of options.
One alternative for glaucoma patients who smoke or vaporize cannabis and experience relief that is too short in duration is to consume edibles. Cannabinoids, when eaten, are metabolized differently because they pass through the stomach and liver instead of the lungs. Therefore, the same amount of cannabis, when infused into an edible, can provide not only additional potency, but also relief for four to eight hours. Especially potent baked goods or chocolate may provide relief for even longer periods. The problem with edibles, unfortunately, is slow onset.
Whereas smoked or vaporized, cannabis begins taking effect after about only 2.5 minutes. Edibles, however, require one to two hours to provide relief. Another credible avenue of consumption for glaucoma sufferers is sublingual sprays and tinctures. These unique and highly discreet avenues of consumption begin providing relief in 10 to 20 minutes and allow patients to medicate when at work, traveling, or among those who disapprove of cannabis.
A 1975 study published in the journal Investigative Ophthalmology revealed that pressure within the eye was reduced after smoking “a socially relevant dose of marijuana (12 mg. delta9-9-tetrahydrocannabinol).” However, the study also found that the pressure reduction experienced by patients occurred only in those who smoked “light to moderate” amounts of cannabis and who perceived a psychoactive effect. This reveals that the cannabinoid THC, because it is the only major component of cannabis to cause a psychotropic effect, was likely the molecular motivator for the IOP reduction.
A 1998 study published in the journal Molecular Brain Research discovered that the expression patterns of CB1 receptors located throughout the brain and Central Nervous System (CNS) — which have a very high binding affinity with the THC molecule — indicate a “specific role” for this special receptor within the endocannabinoid system in terms of controlling intraocular pressure and being an effective antiglaucoma therapy.
A 2004 study published in the British Journal of Ophthalmology found that glaucoma, unlike many conditions effectively treated by cannabis, does not gain direct relief from the effect of cannabinoids and terpenes on the CNS, as had been previously assumed. Instead, this study identified the fact that the efficacy provided by cannabis is localized, with cannabinoid receptors located within the eye itself.
This research also revealed that glaucoma sufferers gain relief not only from smoking or vaporizing cannabis, but also from topical applications of cannabinoids. This study theorized that cannabinoids may increase blood flow to the eye, thus delivering essential nutrients to heal and repair it.
“Cannabinoids have vasorelaxant properties and so might be able to increase the ocular blood flow.”
A recent 2016 study published in the journal Current Opinion in Ophthalmology stated that recent research has revealed little more than what has been known for the past 30 to 40 years: It concluded — once again — that cannabis has a positive effect on lowering IOP in glaucoma patients.
“The pharmacology of marijuana and its effect on intraocular pressure has not changed since the research in the 1970s and 1980s. Marijuana is an effective ocular hypotensive agent.”
More Research Needed
It is unfortunate that cannabis is considered a dangerous and highly addictive substance with zero medical benefit by the United States federal government via inclusion in Schedule I of the Controlled Substances Act. Until Congress recognizes patient testimonies, permits research and human trials, and shows the courage to remove cannabis from the Controlled Substances Act — or reclassify it to Schedule III or lower — patients will continue to needlessly suffer.
This post was originally published on February 16, 2016, it was updated on October 3, 2017.