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Abstract
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Glaucoma is the leading cause of irreversible blindness worldwide(1). It occurs more frequently in elderly individuals, but it can also develop in young adults, children, and newborns. Glaucoma is characterized by the dysfunction and loss of retinal ganglion cells (RGCs), with corresponding structural changes in the optic nerve, and visual field loss, ultimately leading to blindness(2). Although the mechanism behind RGC damage in glaucoma is not fully understood, intraocular pressure (IOP) reduction decreases the development and progression of the disease(3).
Several drugs can be used to treat glaucoma, such as prostaglandin analogs, beta-blockers, alpha-agonists, carbonic anhydrase inhibitors, and cholinergic agonists. A combination of these drugs is also available for patients who have not achieved adequate IOP control. In addition, laser trabeculoplasty can be used to increase aqueous outflow facility through the trabecular meshwork and reduce IOP in cases of open-angle glaucoma. Conventional incisional procedures, such as trabeculectomy and glaucoma drainage devices, are usually indicated for cases wherein a more pronounced IOP reduction is necessary. More recently, so-called minimally-invasive glaucoma surgeries have been presented, which focus mostly on increasing aqueous humor outflow.
In recent years, the use of alternative therapies have been increasing in Western cultures, especially for the treatment of glaucoma, whether for hypotensive or neuroprotective effects(4). It is estimated that 5% of glaucoma patients use alternative therapies(5). One of these possible alternatives is the use of marijuana. Marijuana remains an illegal substance; however, canabidiol (CBD), one of its non-psychoactive compounds, has recently been approved for restricted medical use in Brazil and other countries. Historically, medical marijuana refers to the use of Cannabis sativa and its derivatives, such as CBD and tetrahydrocannabinol (THC), to treat disease or to relieve disease, symptoms(6). The use of medical marijuana dates back 400 years. Despite having several side effects (e.g. chemical dependence, psychiatric disorders, cardiac, hepatobiliary, and gastrointestinal effects), several countries, such as Canada, Czech Republic, Germany, Italy, Holland, and 23 American states, have authorized the use of marijuana for medical purposes.
In conclusion, at present, there is no evidence to support the medical use of marijuana or its compounds for the treatment of glaucoma due to its transitory effect, psychoactive nature, and addictive characteristics. In addition, there is a lack of evidence of its possible effects on glaucoma disease progression. Moreover, illegally obtained marijuana can have toxic contaminants and a much lower level of the supposed therapeutic compounds. Traditional therapeutic options offer greater medical benefits and fewer side effects, and thus are still the best alternatives for glaucoma treatment.
Language: en |