Consensus: marijuana has no role in glaucoma management

Chicago-As more state legislatures are relaxing anti-marijuana laws, physicians are being put in the middle by patients requesting prescriptions or authorizations for its use for medical needs, said Marc F. Lieberman, MD.

Discussing the topic of medicinal cannabis for glaucoma, Dr. Leiberman explained that the consistent conclusion-based on years of study-is that marijuana is less effective than currently available topical glaucoma therapies and is inappropriate for glaucoma management.

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“At the end of 2014, there is broad consensus from the FDA, the National Eye Institute, and ophthalmological societies . . . that there is no current role for use of cannabis agents in the management of glaucoma,” said Dr. Lieberman, clinical professor of ophthalmology, University of California San Francisco. “I encourage all of us as ophthalmologists to proclaim clearly there is no therapeutically useful reason for marijuana to be used as management for chronic IOP reduction.

“In my personal practice, I educate my patients, I refrain from prescribing marijuana, and I try to do no harm,” he continued.

Discussing evidence on the ocular effects of marijuana inhalation, Dr. Lieberman said that research performed over 40 years ago showed that its IOP-lowering effect was modest at best. At that time-when marijuana had about a 2% THC concentration-IOP was reduced by about 20% to 30%. However, the effect wore off after 3 to 4 hours.

“Translating this duration into medical use for glaucoma would require smoking over 3000 joints a year,” Dr. Lieberman explained.

Dr. Lieberman also called attention to potential safety concerns.

While some particularly pertained to use by adolescents and teens, he pointed out that recent marijuana use (within 3 hours) has been implicated in doubling automobile driver accidents.