Ask the Expert: Do alternative medications for glaucoma work?

Answers provided by Dr. Mitchell Gossman, M.D., ophthalmologist at Eye Associates of Central Minnesota, St. Cloud


Question: Do alternative medications for glaucoma such as marijuana, alcohol, and coffee work?


Back to basics: Glaucoma is a disease of the optic nerve that can result in loss of vision and even blindness. It causes no symptoms at all until it’s far advanced. Pain is seldom associated with glaucoma, and the loss of vision is permanent. It is usually, but not always, associated with high eye pressure, and glaucoma can only be diagnosed and detected early with an eye exam.


Treatment of glaucoma is directed toward lowering of the eye pressure. This can be done with drops, oral medication, laser surgery, and surgery on the eye in the operating room. The most common starting treatments are drops and laser procedures, but if glaucoma is far advanced from the outset, surgery may be required to get the pressure to safe levels.


What about unconventional “over the counter,” i.e. non-prescription treatments such as marijuana, alcohol, and coffee/caffeine?


First, alcohol. This has recently been shown to be associated with loss of vision due to glaucoma. However, this association is not so severe that most doctors counsel patients to stop alcohol use. Moderate alcohol use is probably reasonably safe.


Second, coffee. This has been shown to be associated with an increase in eye pressure. Fortunately for you coffee drinkers, it has not been shown to be a lasting and significant elevation.


Both alcohol and marijuana have some affect on glaucoma. This article explores some of those affects. Stock photo

Third, marijuana, also known as cannabis. There is increased interest in treatment of eye pressure with medical and recreational marijuana which contains THC, the active ingredient that produces the “high.” It’s long been known that THC does lower eye pressure, and there is ongoing research into the possibility of an eyedrop using THC as the active ingredient. There is no such eyedrop yet available. That leaves the only way to deliver THC by eating or smoking marijuana. This does result in lower eye pressure, but the effect is short-lived and requires you to consume doses high enough to get you stoned, and so frequently that you would be stoned all the time. Also, nighttime is an important time for pressure to be controlled, and it’s not practical to go without sleep and smoke marijuana. Obviously, it’s not practical to be stoned all the time, unsafe for many activities. Also, the pressure-lowering effect is not significant when compared with currently accepted treatments.


Why, then, is cannabis designated by many states as legal for glaucoma? It is on the list of conditions that may be treated with medical marijuana in Minnesota. I do not know how this slipped into the law, so this is a very good question for your lawmakers. I personally know of no ophthalmologist who prescribes medical marijuana for glaucoma, and the American Glaucoma Society specifically advises against it. Proper treatment is best determined by your eye doctor.

Find Out More

Dr. Mitchell Gossman is a comprehensive ophthalmologist at Eye Associates of Central Minnesota. The office is located at 628 Roosevelt Road, Suite 101, in St. Cloud. To make an appointment or to learn more, call 320-774-3789 or email info@eaofcm.com.

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