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Medical Forum / Diseases and Disorders / Glaucoma / December 2004Marijuana
Tom, I did not read any opposite agenda in Dr. Cohn message. Instead, I always have seen him, for a long time, trying to help us, glaucoma sufferers, explaining and clarifying many aspects of the disease. Small pupil ( a glaucoma sufferer) Tom wrote: " <eyeguyrc@aol.com> wrote in message news:1103335401.798055.175620@z14g2000cwz.googlegroups.com... > While it is true that the harmful side effects of marijuana may be >--- Product information about Xalatan: http://www.pfizer.com/download/uspi_xalatan.pdf This does not strike me as exactly safe, and this is the research from Pfizer and we can see with Celebrax that we cannot be completely confident in that which a drug company says about their product when they are making so much money from their product. I am also disturbed that you are impugning my motives here. This suggests that you have an agenda. I do have an agenda, which is to find out as much as possible about all possible treatments to reduce IOP. Apparently your agenda is exactly the opposite. " > Tom, > [quoted text clipped - 3 lines] > > Small pupil ( a glaucoma sufferer) If my response was rude, I apologize. Dr. Cohn wrote the following: "While it is true that the harmful side effects of marijuana may be overstated, it has not been found to be a useful IOP-lowering agent because of its short duration of action. In order to keep your IOP low enough to protect your optic nerve, you would have to be stoned 24/7." I would be grateful if Dr. Cohn posted the details of any scientific studies which lead to this conclusion. <snip> > Dr. Cohn wrote the following: > [quoted text clipped - 6 lines] > I would be grateful if Dr. Cohn posted the details of any scientific > studies which lead to this conclusion. I'm not Dr. Cohn, but you can find reference here http://www.medmjscience.org/Pages/reports/nihpt4.bhtml (first reference that came up when I did a google search on "marijuana iop") "The dose of marijuana necessary to produce a clinically relevant effect in the short term appears to produce an unacceptable level of undesirable side effects such as euphoria, systemic hypotension, and/or dry eye and conjunctival hyperemia in the majority of glaucoma patients in whom the drug has been carefully studied. No data have been published on studies of long-term ocular and systemic effects of the use of marijuana by glaucoma patients." Mind you, hypotension is a serious risk factor *for* glaucoma. Glaucoma is *not* elevated intraocular pressure, but damage to the optic nerve and if the optic nerve isn't well "fed" by an adequate blood supply, damage will ensue. A study done in 1975 indicated that the IOP returned to baseline about 4 hours after smoking. The Glaucoma Research Foundation also has an article on their website at http://www.glaucoma.org/treating/treatment/marijuana.html which states "The high dose of marijuana necessary to produce a clinically relevant effect on IOP in the short term requires constant inhalation, as much as every three hours. The number of significant side effects generated by long-term oral use of marijuana or long-term inhalation of marijuana smoke make marijuana a poor choice in the treatment of glaucoma, a chronic disease requiring proven and effective treatment." Sherry > <snip> > > [quoted text clipped - 40 lines] > > Sherry I have read studys that indicate the lower your blood pressure the better. I doubt very much that hypotension is a problem for the optic nerve. I also am not so sure that THC causes hypotension. I am wondering if there is anything further on the following: ". . . Because the possibility exists that marijuana (or its components) may be useful in treating glaucoma, the American Academy on Ophthalmology Committee on Drugs believes that a long term clinical study, designed to test the safety and efficacy of marijuana in the prevention of progressive optic nerve damage and consequent visual field loss, appears appropriate." I have also read the warnings for Xalatan which apparently is one of the safer drops to lower IOP. I do not understand why infection is an issue with this drug and seemingly all the others. Infection does not appear to be an issue with contact lens solution. Or visine for that matter. Seems to me infection is a possibility with * anything * you put in your eye, simply because you're putting something foreign into it. Hence, wash your hands, don't touch the bottle tip, etc. Laura >I have also read the warnings for Xalatan which >apparently is one of the safer drops to lower IOP. >I do not understand why infection is an issue with >this drug and seemingly all the others. Infection does >not appear to be an issue with contact lens solution. >Or visine for that matter. > Seems to me infection is a possibility with * anything * you put in > your eye, simply because you're putting something foreign into it. [quoted text clipped - 8 lines] > >not appear to be an issue with contact lens solution. > >Or visine for that matter. So is there any more danger of infection with glaucoma eye drops than there is for soft contact lens rewetting solution for example? It seems from reading the product information for these drugs that the bottle is easily contaminated. I don't know. I guess that would be more for the doctor to answer. I do know that with certain preservative-free products, such as single-use lubricant vials like Bion Tears, I have to be more careful and use them within a certain amount of time after opening the packet because they don't have preservatives. I still use them because some preservatives irritate my eyes. Laura >So is there any more danger of infection with glaucoma >eye drops than there is for soft contact lens rewetting >solution for example? It seems from reading the >product information for these drugs that the bottle >is easily contaminated. <snip> > So is there any more danger of infection with glaucoma > eye drops than there is for soft contact lens rewetting > solution for example? It seems from reading the > product information for these drugs that the bottle > is easily contaminated. Product information from Drugs.com for Visine which can be found at (using TinyURL for the link) http://tinyurl.com/6ew85: "Do not touch the dropper to any surface, including the eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in the eye." I have several bottles of different types of lubricating drops - they all warn about not touching the tip to anything to avoid contamination. Contact lenses, if not properly cared for, can cause serious eye infection. I would think that anyone who has purchased contact lenses would be given the instructions for proper care at the time of first getting them. At http://www.eyesearch.com/contact.lens.solutions.htm is instructions for the different types of lenses mentioning the need for disinfecting. Sherry Hi Laura In answer to your question about infection rates from eye drops, the probability of infecting yourself is directly related to the probability of infecting the bottle (contents or surface) subject to the way you use it. And the probability of infecting the bottle (contents or surface) is dependent upon (a) the length of time it has been open (b) the method of storage (say, refrigerator vs. shelf) (c) any chemical preservatives contained and (d) the manner of infection such as touching the bottle tip to infected areas such as eyelids. For example, to minimise the chance of infecting the bottle and subsequently yourself, discard the remaining contents after a specific time (four weeks in Australia). Refrigerate the bottle (please only do this after your doctor has advised it is safe), and use preserved drops (unless they are individual dose units), and do NOT touch the tip to your eyelid. nor leave the bottle cap off, nor leave the bottle cap upside down (acting like a cup for airborne pathogens) during drop insertion, nor share a bottle with another person. These principles apply to any form of liquid that comes into contact with humans (you don't leave the milk open and unrefrigerated), including contact lens solutions or visine. The way I describe this to my patients is by saying that the moment a bottle is opened, it becomes a bacteria farm. Best wishes Mark in Sydney > > Seems to me infection is a possibility with * anything * you put in > > your eye, simply because you're putting something foreign into it. [quoted text clipped - 14 lines] > product information for these drugs that the bottle > is easily contaminated. Good way to put it! Thanks. Laura >The way I describe this to my patients is by saying that the moment a bottle >is opened, it becomes a bacteria farm. > Good way to put it! Thanks. > > Laura > > >The way I describe this to my patients is by saying that the moment a bottle > >is opened, it becomes a bacteria farm. Doesn't a bacteria farm need food for the bacteria? I dont mean to be argumentative here, but my experience with contact lenses suggests that at least these solutions do not get infected very easily. It used to be that the contact lenses themselves could get contaminated, but that does not seem to be so much of a problem with the newer disenfectant solutions. I have not had an infection in my eye since the disinfection solutions have been around. But I do not wear contact lenses regularly. > Hi Laura > [quoted text clipped - 45 lines] > > product information for these drugs that the bottle > > is easily contaminated. I wear soft contact lenses sometimes, and I guess I am not taking such good care of the bottle. But the solution is a disinfectant so how can it become contaminated? <snip> > I have read studys that indicate the lower your > blood pressure the better. I doubt very much > that hypotension is a problem for the optic nerve. > I also am not so sure that THC causes hypotension. "Marijuana and delta9-tetrahydrocannabinol (THC) increase heart rate, slightly increase supine blood pressure, and on occasion produce marked orthostatic hypotension." http://www.cannabis.net/cardiovascular/ The lower the better for your heart, not your eyes. Both hypertension and hypotension have been implicated as possible risk factors for normal tension glaucoma. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=10416743&dopt=Abstract "Patients who had field progression showed significantly lower nocturnal blood pressure variables, with the dips of the systolic, diastolic, and mean arterial pressure significantly larger " > I am wondering if there is anything further on the > following: [quoted text clipped - 5 lines] > marijuana in the prevention of progressive optic nerve damage and > consequent visual field loss, appears appropriate." "The American Academy of Ophthalmology (1992) stated: "There is evidence that marijuana (or its components), taken orally or by inhalation can lower intraocular pressure. However, there are no conclusive studies to date to indicate that marijuana (or its components) can safely and effectively lower intraocular pressure enough to prevent optic nerve damage. . . . The dose of marijuana necessary to produce a clinically relevant effect in the short term appears to produce an unacceptable level of undesirable side effects such as euphoria, systemic hypotension, and/or dry eye and conjunctival hyperemia in the majority of glaucoma patients in whom the drug has been carefully studied. No data have been published on studies of long- term ocular and systemic effects of the use of marijuana by glaucoma patients." http://www.hivpositive.com/f-Nutrition/MedicalMarijuana/MM- Glaucoma.html > I have also read the warnings for Xalatan which > apparently is one of the safer drops to lower IOP. > I do not understand why infection is an issue with > this drug and seemingly all the others. Infection does > not appear to be an issue with contact lens solution. > Or visine for that matter. Infection is a risk with any eye drops if the tip of the bottle and consequently the fluid itself gets contaminated. Infection is a serious problem with glaucoma patients who have had cutting surgery - trabs, shunts, etc. Contact lens wearers are not only at risk of infection but also corneal ulcers. > <snip> > > [quoted text clipped - 57 lines] > trabs, shunts, etc. Contact lens wearers are not only at risk of > infection but also corneal ulcers. I guess if you have heart failure or some other cardiovascular disease you may not want to lower your blood pressure. But for the most part, low blood pressure is good for your organs. I am pretty certain that low blood pressure is good for your brain, and therefore it must be good for your optic nerve. I am not a doctor but I would be very surprised to be wrong here. I also dont think that THC reduces blood pressure or this would be another medicinal use for it and I dont think this is the case. I would be less surprised if I was wrong here there. |
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