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Ocular Disease and Eye Function – Medical Cannabis for the Treatment of Macular Degeneration

Nature has many ways of making it hard for people to see. As we age, we notice subtle little signs that tell us that our vision is changing. Perhaps you need glasses to see up close or you have trouble adjusting to glare or distinguishing some colours. These changes are a normal part of ageing. They should not stop you from enjoying an active lifestyle or stop you from maintaining your independence. In fact, many people can live an active life well into their golden years without ever experiencing severe vision loss. But, as you age, you are at a higher risk of developing age-related diseases and conditions. They include age-related macular degeneration, cataracts, diabetic eye disease, glaucoma, low vision and dry eyes.

AGE-RELATED MACULAR DEGENERATION (AMD)

AMD is a common eye condition and a leading cause of vision loss among people aged 50 and older. It causes damage to the macula, a small spot near the centre of the retina and the part of the eye needed for sharp, central vision, which lets us see objects that are straight ahead.

In some people, AMD advances so slowly that vision loss does not occur for a long time. In others, the disease progresses faster and may lead to a loss of vision in either one eye, or both eyes. As AMD progresses, a blurred area near the centre of vision is a common symptom. Over time, the blurred area may grow larger or you may develop blank spots in your central vision. Objects may also not appear to be as bright as they used to be.

AMD itself does not lead to complete blindness. However, the loss of central vision in AMD can interfere with simple, everyday activities, such as the ability to see faces, drive, read, write, or do work that require up-close vision.

THE MACULA

The macula is responsible for focusing the central vision of the eye. Without the macula, we couldn’t recognise colours or faces, which would make us unable to drive, read or see objects in detail. With macular degeneration, the macular generally deteriorates. As the cells begin to fail, images aren’t received properly, leading to blurred and distorted vision. Eventually, a blind spot will develop in the centre of a patient’s vision. As MD progresses, the blind spot expands until all central sight is completely lost, although peripheral vision remains intact.

Macular degeneration occurs in two basic type – dry and wet MD.

  1. DRY MACULAR DEGENERATION

Almost all MD is considered dry, or atrophic – around 85 to 90% of macular degeneration cases fall into this category. In dry MD, blood serum doesn’t leak into the retina. Instead, the deterioration of the macula is due to small, yellow deposits of amorphous and acellular debris called drusen. The formation of drusen causes the macula to thin and dry out, which ultimately leads to loss of function. Almost all people over the age of 50 will have at least some drusen in their retina, but only large drusen deposits lead to MD. Dry MD tends to progress more slowly than wet MD and vision loss is often less serious.

  • WET MACULAR DEGENERATION

Wet or exudative macular degeneration occurs in roughly 10 to 15% of MD cases. This form progresses rapidly, often leading to severe vision loss and impairment. In wet MD, abnormal blood vessels called choroidal neovascularization (CNV) form under the retina. As they grow, CBN vessels tend to bleed and leak fluid into the macula. This influx of fluid makes the macula lift or bulge – which damages and distorts central sight. A sign of wet MD is a dark blind spot in the middle of the person’s vision. Often, straight, clear lines appear distorted, blurred, or wavy. While peripheral vision is typically unaffected by wet MD, people can lose most or all of their central sight.

STAGES OF MACULAR DEGENERATION

Macular degeneration is grouped into three stages of progression – early, intermediate and late MD.

  • Early MD: In the early stages of macular degeneration, most people do not experience any significant vision loss. Doctors diagnose early MD by looking for the presence of medium-sized drusen beneath the retina.
  • Intermediate MD: During the intermediate stage of MD, some vision loss is common, but is often not noticeable enough to cause alarm. In this stage, drusen deposits are large, and the retina often exhibits changes in pigment.
  • Late MD: At this stage of MD, vision loss is noticeable and affects normal, daily function.

CAUSES OF MACULAR DEGENERATION

The exact causes of macular degeneration are unknown, and we need more research to fully understand the disease. However, the cause of MD is thought to be a combination of both hereditary and environmental factors.

According to the Mayo Clinic, researchers have identified several risk factors for developing MD, including the following:

  • Smoking: Individuals who smoke double their chances of developing MD later in life;
  • Race: Caucasians have a higher chance of developing MD than other races;
  • Genetics: If you have a family history of MD, you are at higher risk of developing the disease;
  • Age: The risk of MD increases as you age – macular degeneration most often develops in people who are 55 years old or older.

SYMPTOMS OF MACULAR DEGENERATION

The symptoms of macular degeneration revolve around vision. In dry MD, the light-sensitive retina cells deteriorate, leading to blind spots. Alternatively, people with MD are more likely to notice wavy and distorted lines and details as fluid leaks into the macula.

The most common symptoms of macular degeneration:

  • Difficulty recognising faces, words and details;
  • Blurred and distorted vision;
  • Decreased brightness of colours;
  • Reduced central vision;
  • Straight lines appearing wavy or curved;
  • Difficulty adapting to low light;

Typically, dry MD occurs in both eyes. If only one eye is affected, the patient may not notice any significant vision changes – the good eye will compensate for the affected one.

Available treatments for Macular Degeneration:

  1. Laser Photocoagulation Treatments;
  2. Anti-VEGF Therapy

MEDICAL CANNABIS AS AN ALTERNATIVE TREATMENT FOR MACULAR DEGENERATION

Before exploring the possibility of using medical cannabis as an alternative treatment for macular degeneration, we must first understand how cannabis works:

Cannabis interacts with the body’s natural endocannabinoid system (ECS). Researchers are still analysing the role of the ECS, but what we have learned so far is astonishing. According to current research, the endocannabinoid system plays a role in maintaining homeostasis in the body. It helps regulate a wide range of functions, including metabolism, appetite, immune response, memory, and intercellular communication.

The endocannabinoid system has two different types of receptors – CB1 and CB2. While CB2 receptors occur throughout the peripheral nervous system and the immune system, CB1 receptors primarily cluster in the brain and spinal cord. When you consume cannabis, it enters the bloodstream and binds to either CB1 or CB2 receptors. Cannabis is filled with chemical compounds called cannabinoids. Researchers have identified at least 85 cannabinoids within cannabis, and each one has a slightly different effect. The two primary cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD). Their main difference revolves around with endocannabinoid receptors they bind to – while THC primarily targets CB1 receptors, CBD mainly binds with CB2 receptors.

Because it binds to the receptors in the brain and spinal cord, THC is known as the cannabinoid that causes psychoactive effects. Alternately, CBD doesn’t affect the brain – primarily targeting the immune system, CBD gives all the therapeutic benefits of cannabis, without the “high”.

Symptoms of macular degeneration

HOW MEDICAL CANNABIS CAN TREAT MACULAR DEGENERATION

Until recently, cannabis has been considered an illegal substance across most of the world. Historically, it has been difficult to acquire research permits, making the study of cannabis near impossible. Cannabis research, while not new, is a growing field, and currently, no research has been directly conducted on the effect of cannabis on MD.

However, what we do know about cannabis indicated that it may help manage and reduce the symptoms of macular degeneration. Recent studies have produced promising results – endocannabinoid receptors have been found around the ocular region, and consuming cannabis has been found to reduce inflammation, inhibit vascular endothelial growth factor and lower intraocular pressure.

  1. REDUCING INFLAMMATION

Cannabis is a known anti-inflammatory substance, helping a wide range of inflammatory disorders including arthritis and Crohn’s disease. However, cannabis doesn’t just target system-wide inflammation – cannabis has shown anti-inflammatory properties specifically for the area around the retina. This effect is especially seen when the inflammation is connected with diabetes or endotoxin exposure, and both conditions have correlations with Macular Degeneration. Bacterial endotoxins can often be the instigating cause of macular degeneration, and diabetes is shown to be a risk factor of MD.

CBD, in particular, reduces the body’s production of cytokines, which are pro-inflammatory proteins. Additionally, the cannabinoid decreases the activation of vital factors in the inflammation response, lowering the activity of primary pathways that help regulate pro-inflammatory genes.

  • INHIBITING VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF)

Many treatments for MD patients involve injections directly into the eye. These medications aim to halt the growth of vascular endothelial growth factor. But, while these treatments often come with harsh side-effects, cannabis has been shown to have the same effect with little to no negative repercussions. In a 2004 study of brain tumours, researchers found that cannabinoids blocked and inhibited VEGF pathways through the body, showing incredible promise for cannabis as a treatment for macular degeneration. THC seems to be especially effective at targeting VEGF progression, so for balanced results, a full-spectrum cannabis extract that is THC-rich would be advisable.

  • LOWERING INTRAOCULAR PRESSURE

Medical cannabis has been shown to lower intraocular pressure for patients with glaucoma. Glaucoma is associated with macular degeneration, and many patients will develop both conditions. The implications of this research are exciting – while researchers need to conduct further studies, medical cannabis appears to significantly help both eye conditions. Since ocular endocannabinoid receptors have been discovered, researchers hypothesise that topical application of medical cannabis may be just as effective in reducing pressure around the eye.

  • REDUCING SYMPTOMS OF DEPRESSION

Many people with macular degeneration develop depression as a reaction to learning that they may lose their eyesight. Older adults are particularly at risk, with studies showing nearly 40% of older adults with MD also suffer from depression. This is 6% higher than depression rates among individuals with other visual impairments and 24% higher than rates in normally-sighted individuals. CBD has been shown to have antidepressant qualities and can ease many of the symptoms of depression and anxiety.

While more studies need to be conducted on the effects of macular degeneration, anecdotal evidence suggests that cannabis can profoundly help people who suffer from MD. As with any medication, cannabis will affect each person differently. However, from all the research conducted, together with the anecdotal evidence, we can conclude that medical cannabis shows great promise in treating the symptoms of macular degeneration.

Recent studies have produced promising results – endocannabinoid receptors have been found around the ocular region, and consuming cannabis has been found to reduce inflammation, inhibit vascular endothelial growth factor and lower intraocular pressure.

Macular Degeneration

Updated on May 6, 2020. Medical content reviewed by Dr. Joseph Rosado, MD, M.B.A, Chief Medical Officer

Most likely, you know someone who has been touched by macular degeneration (MD). The leading cause of vision loss across the United States, MD affects over 10 million Americans of all ages, which is more than glaucoma and cataracts combined.

If you are interested in exploring alternative treatment for macular degeneration, medical marijuana provides a holistic and effective option. Before we dive into the potential of cannabis for treating MD, we will cover the disease, its symptoms, and available treatments.

How Medical Marijuana Treats Macular Degeneration

Until recently, marijuana has been considered an illegal substance across much of the world. Historically, it has been hard to acquire research permits, making the study of cannabis difficult. Marijuana research is a new and growing field, and currently, no research has been directly conducted on the effect of cannabis on MD.

However, what we do know of cannabis indicates that it might help manage and reduce the symptoms of MD. Recent studies have produced promising results — ECS receptors have been found around the ocular region, and consuming cannabis has been found to reduce inflammation, inhibit vascular endothelial growth factor and lower intraocular pressure.

1. Reduces Inflammation

Cannabis is a known anti-inflammatory substance, helping a wide range of inflammatory disorders including arthritis and Crohn’s disease. However, cannabis doesn’t just target system-wide inflammation — marijuana has shown anti-inflammatory properties specifically for the area around the retina.

This effect is especially seen when the inflammation is connected with diabetes or endotoxin exposure, and both conditions have correlations with MD. Bacterial endotoxins can often be the instigating cause of macular degeneration, and diabetes is shown to be a risk factor of MD.

CBD, in particular, reduces the body’s production of cytokines, pro-inflammatory proteins. Additionally, the cannabinoid decreases the activation of vital factors in the inflammation response, lowering the activity of primary pathways that help regulate pro-inflammatory genes.

In general, Sativa strains of marijuana are high with THC compounds, while Indica strains have high CBD levels. The best strains of cannabis to fight inflammation include:

  • Purple Urkle(Indica): Purple Urkle is an Indica strain that gives users anti-inflammatory effects along with inducing sleep and deep relaxation, making it a perfect before-bed medication.
  • God Bud (Hybrid): God Bud is a powerful Indica-dominant hybrid strain that is known for reducing pain and inflammation.
  • Cannatonic(Hybrid): Another Indica-dominant hybrid, Cannatonic fights inflammation while relaxing the body and reducing pain, anxiety, and migraines.

Because CBD shows particular results in reducing inflammation, Indica strains or hybrids with a high Indica content are the best choices for anti-inflammatory treatment.

2. Inhibits Vascular Endothelial Growth Factor (VEGF)

Many treatments for MD patients involve injections directly into the eye. These medications aim to halt the growth of vascular endothelial growth factor. But while these treatments often come with harsh side effects, cannabis has been shown to have the same effect with little to no negative repercussions.

In a 2004 study of brain tumors, researchers found that cannabinoids blocked and inhibited VEGF pathways through the body, showing incredible promise for cannabis as a treatment for macular degeneration. THC seems to be especially effective at targeting VEGF progression, so for balanced results, try a balanced hybrid or a slightly-THC leaning strain such as the ones below.

  • Cannatonic (Hybrid): This hybrid strain has nearly equal levels of THC and CBD, giving a calming, focused and happy effect. Since it is also effective at reducing inflammation, it is an effective strain for treating MD.
  • Canna-Tsu (Hybrid): Another balanced hybrid, Canna-Tsu provides users with deep relaxation and an uplifted, focused and happy mental boost. The THC content will combat VEGF progression, while the CBD will calm inflamed tissue.

When looking for the right strain of medical marijuana for your unique needs, work closely with a certified marijuana doctor and dispensary — they will be able to give you personalized and expert insight into finding the ideal type of cannabis.

3. Lowers Intraocular Pressure

Medical marijuana has been shown to lower intraocular pressure for patients with glaucoma. Glaucoma is associated with MD, and many patients will develop both conditions. The implications of this research are exciting — while researchers need to conduct further studies, medical marijuana appears to significantly help both eye conditions.

Since ocular ECS receptors have been discovered, researchers hypothesize that topical application of medical cannabis may be just as effective in reducing pressure around the eye.

  • Super Skunk (Indica): Super Skunk is a favorite strain for patients with glaucoma. It relaxes muscles, lowers stress and reduces eye pressure.
  • OG Poison (Hybrid): This hybrid is known to cause sleep, making it a perfect evening medication for relieving stress, insomnia, pain, and pressure.

4. Eases Depression Symptoms

Many people with macular degeneration develop depression as a reaction to learning they may lose their sight. Older adults are particularly at risk, with studies showing nearly 40 percent of older adults with MD also have depression. This is six percent higher than depression rates among individuals with other visual impairments, and 24 percent higher than rates in normally-sighted individuals.

CBD has already been shown to have antidepressant qualities and can ease many of the symptoms of depression and anxiety.

  • Jack Herer (Sativa): This powerful strain is best used in low doses. It improves mood and provides users with a feeling of well-being.
  • Harlequin (Hybrid): Harlequin is a CBD-dominant strain that doesn’t get users “high.” It can improve users’ mood and outlook and clear the mind.
  • Northern Lights (Indica): This Indica strain has a sedative effect, so it’s another good before-bed medication for relieving stress and bringing a deep, relaxing calm.

While more studies need to be conducted on the effects of CBD on macular degeneration, anecdotal evidence suggests that cannabis can profoundly help patients with MD.

Side Effects of Medical Marijuana

Marijuana is a natural and holistic alternative to typical medications for macular degeneration. But as with any treatment, cannabis comes with a few potential side effects. However, almost all the negative side effects of marijuana use can be lessened or eliminated by taking a few extra steps.

Here are a few of the most common side effects of medical cannabis use:

  • Red eyes: While eye redness isn’t harmful, it can cause self-consciousness or embarrassment. To offset any red-eye, try taking some over-the-counter eye drops.
  • Respiratory issues: If you ingest marijuana through inhalation, you are at risk for developing respiratory problems after using for a long time. To offset this risk, experiment with one of the other ways of taking marijuana, such as topicals or edibles.
  • Hunger or thirst: Feelings of “cotton mouth” and the “munchies” are common after using cannabis. Both unpleasant sensations are easily fixed — keep healthy drinks and food nearby before and after you ingest marijuana.

Like any drug, marijuana will affect every person differently. For the best results, consult a certified marijuana doctor and a professional dispensary as you experiment with different strains and ingestion methods.

The Best Ways to Use Medical Marijuana for Macular Degeneration

Smoking a joint is the stereotypical image of marijuana use. However, cannabis products come in a wide range of types and styles, from tinctures and sprays to edibles.

Here are some of the most popular ways to consume medical cannabis:

  • Smoking:Smoking is the most common way to use weed, for both medicinal and recreational users. However, before you begin rolling a joint, remember that just like smoking tobacco products, long-term marijuana smoking can lead to lung damage.
  • Vaping: If you prefer to inhale marijuana but don’t want the higher risk of respiratory damage, try vaping. When compared to smoking, vaporizing cannabis emits a lower number of toxins, making it a safer alternative for prolonged use.
  • Edibles: From gummies to brownies, edible marijuana products are designed to be delicious and accessible to all types of users. Edibles take longer to “kick in” than vaping or smoking, but the effects are often more intense and lasting.
  • Topicals:Topical products are another popular option for medicinal users. Including salves, creams, lotions, sprays and ointments, topicals give localized pain and inflammation relief without risking the marijuana “high.”

Even if you have used marijuana before, experiment with a few different methods — you might find a new favorite.

How to Begin Medical Marijuana Treatment for Macular Degeneration

Macular degeneration is often a frightening and discouraging condition. However, medical marijuana could give you or someone you love hope — if you are interested in pursuing medical cannabis as a treatment for MD, let MarijuanaDoctors.com help.

With an extensive directory of certified marijuana doctors and professional dispensaries, we have the resources you need to find experts near you. Let us help you heal — search for a qualified dispensary and physician today.

What Is Macular Degeneration?

Within the eye, the macula is the central portion of the retina, the inside back layer of the eye. The retina receives images and sends them to the optic nerve, which in turn sends signals to the brain to help interpret what we are seeing.

The macula is responsible for focusing the central vision of the eye. Without the macula, we couldn’t recognize colors or faces, which would make us unable to drive, read or see objects in detail.

With macular degeneration, the macula gradually deteriorates. As the cells begin to fail, images aren’t received properly, leading to blurred and distorted vision. Eventually, a blind spot will develop in the center of a patient’s vision. As MD progresses, the blind spot expands until all central sight is lost completely, although peripheral vision remains intact.

Macular degeneration occurs in two basic types — dry and wet MD.

1. Dry Macular Degeneration

Almost all MD is considered dry, or atrophic — around 85 to 90 percent of macular degeneration cases fall into this category.

In dry MD, blood or serum doesn’t leak into the retina. Instead, the deterioration of the macula is due to small, yellow deposits of amorphous and acellular debris called drusen. The formation of drusen causes the macula to thin and dry out, which ultimately leads to loss of function.

Almost all people over the age of 50 will have at least some drusen in their retina, but only large drusen deposits lead to MD. Dry MD tends to progress more slowly than wet MD, and vision loss is often less serious.

2. Wet Macular Degeneration

Wet, or exudative, macular degeneration occurs in roughly 10 to 15 percent of MD cases. This form progresses rapidly, often leading to severe vision loss and impairment.

In wet MD, abnormal blood vessels called choroidal neovascularization (CNV) form under the retina. As they grow, CNV vessels tend to bleed and leak fluid into the macula. This influx of fluid makes the macula lift or bulge, which damages and distorts central sight.

A sign of wet MD is a dark blind spot in the middle of a patient’s vision. Often, straight, clear lines appear distorted, blurred or wavy. While peripheral vision is typically unaffected by wet MD, patients can lose most or all of their central sight.

Stages of Macular Degeneration

Macular degeneration is grouped into three stages of progression — early, intermediate and late MD.

  • Early MD: In the early stages of macular degeneration, most people do not experience any significant vision loss. Doctors diagnose early MD by looking for the presence of medium-sized drusen beneath the retina.
  • Intermediate MD: During the intermediate stage of MD, some vision loss is common, but it is often not noticeable enough to cause alarm. In this stage, drusen deposits are large, and the retina often exhibits changes in pigment.
  • Late MD: At this stage of MD, vision loss is noticeable and affects normal, daily functioning.

Causes of Macular Degeneration

The exact causes of macular degeneration are unknown, and we need more research to fully understand the disease. However, the cause of MD is thought to be a combination of both hereditary and environmental factors.

Researchers have identified several risk factors for developing MD, including the following:

  • Smoking: Individuals who smoke double their chances of developing MD later in life.
  • Race: Caucasians have a higher chance of developing MD than Hispanics or African-Americans.
  • Genetics: If you have a family history of MD, you are at a higher risk of developing the disease.
  • Age: The risk of MD increases as you age — macular degeneration most often develops in people who are 55 years old or older.

Symptoms of Macular Degeneration

The symptoms of macular degeneration revolve around vision. In dry MD, the light-sensitive retina cells deteriorate, leading to blind spots. Alternatively, people with wet MD are more likely to notice wavy and distorted lines and details as fluid leaks into the macula.

Here are some of the most common symptoms of macular degeneration:

  • Difficulty recognizing faces, words, and details
  • Blurred and distorted vision
  • Decreased brightness of colors
  • Reduced central vision
  • Straight lines appearing wavy or curved
  • Difficulty adapting to low light

Typically, dry MD occurs in both eyes. If only one eye is affected, the patient may not notice any significant vision changes — the good eye will compensate for the affected one.

Current Available Treatments for Macular Degeneration

Macular degeneration is considered an incurable disease. However, a range of treatment options tries to slow the progression of MD.

For the early stages of dry MD, treatment often involves nutritional therapy. Supplements high in antioxidants, omega-3 fatty acids and carotenoids are prescribed to strengthen cell structure and increase healthy pigments.

Wet MD typically involves one of two treatment options — laser photocoagulation treatments and anti-VEGF therapy.

1. Laser Photocoagulation Treatments

Until recently, laser therapy was the only way to stop leaking blood vessels in wet MD. After a laser sealed the vessels, the treatment was followed by Photodynamic Therapy (PDT) using Visudyne. This drug was injected intravenously, and while successful in sealing vessels, it does not affect reoccurrence, leading to a 50 percent chance that leakage developed again in a two-year span.

Additionally, Visudyne comes with a host of side effects including tiredness, headaches, chest pain, sweating, and eye pain.

2. Anti-VEGF Therapy

Currently, one of the most common treatments for MD targets the vascular endothelial growth factor (VEGF). VEGF is a molecule responsible for supporting new blood vessels. However, when the macula is damaged, VEGF is a harmful element that promotes the development of new, unhealthy and weak blood vessels in the retina.

Anti-VEGF therapy involves periodic injections of an anti-VEGF chemical into the eye. These chemicals inhibit the growth of any new blood vessels in the macula, leading to a temporary halt in the progression of MD.

Several anti-VEGF chemicals are used to treat MD, including bevacizumab, ranibizumab, and aflibercept. Potential side effects of the drugs include increased eye pressure, eye infection, vitreous floaters and retinal detachment.

Medical Marijuana as an Alternative Treatment

Before we explore how marijuana treats macular degeneration, we must first go into how cannabis works.

Marijuana interacts with the body’s natural endocannabinoid system (ECS). Researchers are still analyzing the role of the ECS, but what we have learned so far is astonishing. According to current research, the ECS plays a vital role in maintaining homeostasis in the body. It helps regulate a wide range of functions, including metabolism, appetite, immune response, memory, and intercellular communication.

The ECS has two different types of receptors — CB1 and CB2. While CB2 receptors occur throughout the peripheral nervous system and the immune system, CB1 receptors primarily cluster in the brain and spinal cord. When you consume cannabis, it enters the bloodstream and binds to either CB1 or CB2 receptors.

Marijuana is filled with chemical compounds called cannabinoids. Researchers have identified at least 85 cannabinoids within marijuana, and each one has a slightly different effect. The two primary cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD). Their main difference revolves around which ECS receptors they bind to — while THC primarily targets CB1 receptors, CBD mainly binds to CB2 receptors.

Because it binds to the receptors in the brain and spinal cord, THC is known as the cannabinoid that causes psychoactive effects. Alternately, CBD doesn’t affect the brain — primarily targeting the immune system, CBD gives all the therapeutic benefits of weed without the “high.”

Although recreational users often prefer marijuana with high levels of THC, medical marijuana is often dominant with CBD.

See how medical marijuana could help relieve your Macular Degeneration. Find patient reviews on local doctors and information on treatment options. ]]>