Can CBD Oil Help Macular Degeneration

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Mandel vision explores the potential benefits of Cannabidiol, or CBD, products in this blog post. | Mandel Vision | Blog Post CBD may be used to treat macular degeneration because of its reported neuroprotective properties that could benefit patients with retinal disorders. Learn more. What do CBD, cannabis, and marijuana have do with with optometric care? Find out.

The Many Potential Health Benefits of CBD (Cannabidiol)

Cannabidiol, or CBD, products have become extremely popular since the passage of the U.S. Farm Bill in 2018, which legalized industrial hemp and CBD in all 50 states.

What is CBD?

According to Miriam Webster, cannabidiol (CBD) is a crystalline, nonintoxicating cannabinoid (C21H30O2) found in cannabis and hemp that is sometimes used medicinally.[i] Although CBD is the second most abundant of the active ingredients of cannabis, better known as marijuana, CBD is derived directly from the hemp plant and therefore contains only trace amounts of THC. THC is the most abundant psychoactive ingredient in marijuana.

Does CBD cause a “high”?

Since CBD only contains trace amounts of THC, the psychoactive ingredient in marijuana which is the mood-altering component, CBD does not cause a high.

Is CBD approved by the FDA?

Technically, CBD is not approved by the FDA. However, FDA approval isn’t required since it contains only trace amounts of THC. For this reason, it is legal to sell and consume CBD products in the U.S. without FDA approval.

Epidiolex, a medication indicated for the treatment of epilepsy associated with Lennox-Gastaut syndrome or Dravet syndrome, is the first FDA approved medication containing cannabidiol as its active ingredient.

What are the known health benefits of CBD?

Companies are touting the many potential health benefits of CBD. Although with the exception of epilepsy, these benefits are not yet clinically proven, some patients have reported relief from sleep problems, chronic pain, inflammation and anxiety.

A recent study also found that cannabidiol is a potent neuroprotective antioxidant.[ii] This suggests that cannabidiol may eventually play a therapeutic role in the treatment of neurological diseases such as Alzheimer’s and Parkinson’s disease.

Can CBD be used to treat Glaucoma?

CBD should not be used to treat glaucoma. Although marijuana has been shown to lower intraocular pressure (IOP) for very short periods of time, a recent study revealed that CBD oil actually raises IOP.[iii] Neither marijuana nor CBD are adequate treatment options for glaucoma as IOP needs around the clock control in order to prevent damage to the optic nerve, which could eventually lead to blindness if not managed properly. Click here to read more.

Does CBD have any eye health benefits?

It’s too soon for a definitive answer as the ocular effects of CBD are still being researched. However, there are a few possible indications for CBD in ophthalmologic conditions. The antioxidant properties of CBD may help slow the progression of age-related macular degeneration (ARMD or AMD) and the neuroprotective properties may help some retinal diseases such as retinal ischemia.

Is CBD safe?

You should check with your doctor to make sure CBD is not only safe for you, but that there aren’t contraindications between CBD and other medications you are taking. In addition, CBD should not be used as a replacement for other medical treatments unless recommended by a physician. Patients with active systemic disease should continue to see their primary care physicians and specialists to monitor their condition and treatment regimen.

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Best CBD Oil for Macular Degeneration – August 2022

Why People Are Turning to CBD for Macular Degeneration

Cannabidiol ( CBD ) could be used to treat macular degeneration due to its reported neuroprotective effects on retinal neurodegenerative diseases (5) .

Research in 2003 revealed that CBD reduced cell death in rat retinas injected with a substance that copied the effects of glaucoma. The study was reportedly the first demonstration of cannabidiol as a retinal neuroprotectant in vivo (6) .

Researchers in a 2006 study learned that CBD treatment significantly reduced oxidative stress and prevented retinal cell death in diabetic rats (7) .

In another study, cannabidiol was shown to decrease retinal inflammation in rats by blocking cells and structures responsible for neuroinflammation (8) .

Although these findings shed a positive light on CBD as a potential treatment for macular degeneration, all of the current research studies were performed on animals.

There have been no human clinical trials completed to prove that cannabidiol can effectively treat this eye condition .

How CBD Oil Works to Help with Macular Degeneration

A study published in 2008 investigated the role of adenosine signaling in retinal inflammation and how CBD could potentially modulate this pathway. The results showed that adenosine receptors are abundant in rat retinal cells (9) .

The researchers confirmed that the activation of these receptors plays a crucial role in anti-inflammation in the retina. They also added that CBD inhibited adenosine uptake, an action associated with inflammation (10) .

Another potential target for treating eye diseases is through the endocannabinoid system (ECS), a part of the body that regulates functions involving the nervous system and the immune system. The primary cannabinoid receptors of the ECS (CB1 and CB2) are both present in the retina (11) .

CBD has been found to interact with these receptors, even at reasonably low concentrations (12) . Its affinity with the CB2 receptor is believed to play a part in CBD ’s anti-inflammatory properties.

The Pros and Cons of CBD Oil for Macular Degeneration

The Pros
  • Several clinical trials on animals have shown that cannabidiol could be a potential treatment for retinal diseases due to its supposed neuroprotective effects (13) .
  • Researchers consider CBD as a potential retinal neuroprotectant because of its reported ability to reduce cell death in rat retinas subjected to a substance that mimicked the effects of glaucoma (14) .
  • Hemp-derived cannabidiol is now legal, according to the United States 2018 Farm Bill (15) . Americans can buy and use CBD products in most states.
  • CBD is a non-psychotropic compound of cannabis plants . Although CBD is also found in marijuana , it is THC that causes the mind-altering effects.
  • The U.S. Food and Drug Administration supports research on cannabidiol and other cannabis products (16) . The agency also recognizes the potential benefits of CBD .
The Cons
  • There are no human clinical studies that prove CBD to be an effective treatment for macular degeneration.
  • Most of the studies on cannabidiol have been performed on animal models, making it difficult to determine if it can be used to treat certain medical conditions .
  • Cannabidiol is not a risk-free substance. Human studies have shown CBD consumption to be associated with drug interactions, diarrhea, fatigue, and vomiting (17) .
  • Health insurance firms in the United States do not cover CBD or medical marijuana , even if prescribed by a physician.
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How CBD Oil Compares to Alternative Treatments for Macular Degeneration

A study on age-related macular degeneration ( AMD ) analyzed dietary supplements as a potential approach to delay the development of the condition. A formula that contained vitamin C, vitamin E, and beta-carotene have been mentioned in the assessment (18) .

One study showed that using a combination of these nutrients could significantly decrease the chances of progression to an advanced type of macular degeneration (19) .

A study published in the journal Antioxidants stated that vitamin C and E are effective nutrients in minimizing the risk of developing macular degeneration. They also stated that carotenoids, such as beta-carotene, are known for their protective effects against eye diseases and macular degeneration (20) .

Similarly, cannabidiol is said to have antioxidant and anti-inflammatory properties that could be used for many health conditions (21) .

One study claimed that CBD is a more effective neuroprotective antioxidant than vitamin C and E (22) .

How to Choose the Right CBD for Macular Degeneration

The three variants of CBD that users can purchase today are full-spectrum, broad-spectrum, and isolate.

Full-spectrum CBD is perhaps the most well-known of the three. This form of cannabidiol has all of the natural components of cannabis plants , including THC , flavonoids, and terpenes.

High-quality full-spectrum CBD has high cannabidiol content and small amounts of the other compounds present. Full-spectrum CBD is also known for the “entourage effect,” a synergism wherein all cannabis constituents are more efficient when taken together (23) .

The second variant of CBD is called broad-spectrum. This type is very similar to full-spectrum, in that it also has various cannabinoids present.

The main difference between the two is that broad-spectrum CBD does not contain THC . Some people prefer broad-spectrum because they wish to avoid the psychotropic effects of tetrahydrocannabinol .

The last form of CBD is the isolate. CBD isolates are made of pure cannabidiol and are often sold as crystals or powder.

Due to how pure they are, CBD isolate products do not have a distinct taste or smell.

Of the three, full-spectrum CBD oil is perhaps the most potent type of cannabidiol because of the entourage effect.

No matter the form one chooses, it is essential to acquire the highest quality CBD products available.

The following are some tips to assist users in obtaining the best CBD products:

  • Acquire a lab report or certificate of analysis (COA) for the chosen item. A COA is a document detailing and showing the exact content of the CBD product.
  • Hemp plants are the best sources of getting high-quality cannabidiol . Be wary of brands that do not use industrial hemp in creating their CBD products.
  • Know the legalities about buying and using CBD in the various states, particularly where one decides to consume the compound.
  • Testimonials and reviews can help users select a reputable CBD brand for their needs. When buying from a dispensary, ensure that the establishment is authorized to sell cannabidiol products.
  • Consult a medical expert before buying any CBD product. A doctor who is experienced in medical cannabis is highly recommended.

CBD Dosage for Macular Degeneration

As of this writing, the FDA has not released official guidelines concerning CBD dosage. This predicament makes it hard for users to know the proper dose range that could benefit patients with retinal disorders.

However, one can look at clinical trials in the past to identify a safe amount of CBD to take.

In a 2017 study, healthy volunteers, who were given 600 mg of cannabidiol , experienced the desired effect of the compound without adverse side effects .

Meanwhile, taking as much as 1,500 mg of CBD each day has been reported to be well-tolerated in human subjects (24) .

First-time users may also talk to a medical expert to know a suitable dose range for CBD .

How to Take CBD Oil for Macular Degeneration

CBD in the form of edibles is one of the easiest ways to consume cannabidiol . Most brands sell CBD gummies that come in various flavors.

There are also CBD capsules and tablets that can be taken in the same manner as supplements.

For users looking to apply CBD immediately, sublingual administration is the preferred method. Taking substances under the tongue has proven to be a faster way compared to the traditional oral route (25) .

CBD tinctures also have droppers that make it easier for people to measure how much of the compound they are going to take.

Inhaling cannabidiol by way of vaping devices is also another quick way of taking CBD because of its high bioavailability (26) . Bioavailability is the measurement of how much a substance enters the body successfully.

However, CBD vapes are not recommended for people with lung problems. The use of vaping products has been implicated in pulmonary toxicity and lung injury (27) .

What is Macular Degeneration?

Age-related macular degeneration , also called AMD , is an eye disorder that causes blurring of the sharp, central vision required for many activities. The condition affects the area of the eye known as the macula and is prevalent in older adults .

Some AMD patients may experience minimal peripheral vision loss or none at all.

AMD happens frequently and is a leading cause of vision loss for individuals above the age of fifty (28) . Although AMD does not result in complete blindness, it can take away much of a person’s central vision , making it very difficult to see.

In some cases, macular degeneration develops slowly. People with early stages of AMD may not always experience vision loss right away.

For others, AMD progresses rapidly and can lead to the loss of vision in one eye .

Wet and dry AMD are the two forms of macular degeneration. Wet AMD is when abnormal blood vessel growth in the eye starts to leak and cause damage, leading to rapid loss of central vision . On the other hand, dry AMD progresses slowly, but can generally affect both eyes (29) .

The causes of macular degeneration remain unclear. However, experts believe environmental factors, such as smoking, alcohol, and diet, and heredity plays a role in AMD .

A person with dry macular degeneration may experience visual impairments, reduced central vision in one or both eyes, and difficulty in adjusting to low light levels.

In wet macular degeneration , abnormal blood vessels begin to leak blood or fluid into the macula. This leakage leads to blurred vision or the development of a blind spot within a person’s visual field .

Macular degeneration has three stages:

  • Early-stage AMD – Presence of medium-sized drusen deposits or deposits of dead cells in the retina. An individual with early-stage AMD does not experience pigment changes and vision loss .
  • Intermediate AMD – Presence of large drusen deposits and significant pigment changes. Although most do not experience any other problems, mild vision loss is a possibility.
  • Late-stage AMD – A person has dry or wet macular degeneration that leads to vision loss .
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There are several factors involved before the disease can progress to the late-stage of macular degeneration. The size of the deposits that are formed in the retina is one of them (30) .

Approximately one out of three individuals with small yellow deposits of drusen begin to experience vision problems within five years. Meanwhile, fifty out of a hundred people with large drusen develop late-stage AMD and vision loss within five years.

How is Macular Degeneration Treated?

Similar to glaucoma patients , people with dry AMD can only rely on treatments to alleviate the symptoms of their condition.

Wet macular degeneration is generally treated using drugs that are injected directly into the eye to stop blood vessel growth . This medication is known as an anti- vascular endothelial growth factor ( anti-VEGF ) and is applied to the VEGF pathways .

Although the treatment does not cure AMD , it is capable of stopping or slowing down its progression. Some individuals experience vision improvements during treatment.

However, repeated eye injections ( Lucentis and Avastin ) have been associated with increased intraocular pressure ( eye pressure ) (31) .

Photodynamic therapy is sometimes used to treat AMD . This method is a two-step process wherein a laser is directed to the affected area to seal and prevent the progression of abnormal blood vessels .

Compared to anti-VEGF drugs, patients taking photodynamic therapy may continue to experience vision loss within six months of treatment. Their condition eventually stabilizes, stopping the eye from progressing to severe vision loss .

Laser photocoagulation is another approach that uses a concentrated beam of heated light. This laser is directed to a part of the retina to destroy and seal any leaky blood vessels .

However, there is a fifty percent chance for AMD to recur after laser photocoagulation. That is why close monitoring by way of an expert ophthalmologist is necessary.

Certain dietary supplements are said to help slow down the progression of the disease. Taking vitamins and minerals, such as vitamin C, vitamin E, beta-carotene, zinc, copper, and lutein, could be beneficial for AMD patients.

Many of these vitamins can be found in green, leafy vegetables.

Patients with macular degeneration are advised to avoid highly processed foods and partially hydrogenated fats. Fat-filled snacks may increase the risk of developing advanced AMD.

Promising New Treatments for Macular Degeneration

Below are some of the upcoming treatments for the wet and dry forms of AMD .

Wet AMD

  • Gene therapy – This type of treatment offers a promising alternative to the constant eye injections to counteract VEGF . This therapy aims to provide patients with a one-and-done treatment by helping the eye create its own anti-VEGF medicine.
  • Port delivery system – This refillable device stores anti-VEGF drugs that are inserted in the wall of the eye through surgery. Its purpose is to continuously release anti-VEGF substances in the eye, which can last for up to two years.
  • Eye drops – Eye drop products for AMD have already been tested in animal trials. Once approved, these drops could become the first at-home solution to help with macular degeneration.
  • Oral tablets – Anti-VEGF drugs as pills have already entered clinical trials . Early results suggest that the medication may be used to reduce or eliminate eye injections.
  • Combination drug treatments – Mixing drugs that are already out on the market may help treat wet macular degeneration . Scientists are experimenting with combination medicines to find a solution that is more effective than the standard treatments.

Dry AMD

  • Stem cell therapies – Using stem cells, doctors could replace the cells lost due to retinal damage in macular degeneration. Although having been tested only in small clinical trials , the results thus far are promising.
  • APL-2 – This injected medication is intended to slow the disease by saving retinal cells from destruction. The drug is currently being tested and is still a few years away from being available to the public.
  • Oracea – This oral antibiotic is currently being tested for its anti-inflammatory properties that could benefit patients with geographic atrophy, an advanced form of AMD .
  • Zimura – This eye injection is meant to slow the progression of geographic atrophy in patients with late-stage macular degeneration.

Conclusion

Cannabidiol has the potential to treat age-related macular degeneration because of its purported neuroprotective effects on retinal diseases.

Several studies have shown that CBD may reduce cell death and oxidative stress in animal retinas, which are conditions that occur during AMD .

Despite the positive findings, there are no clinical trials that directly involve CBD as a treatment for macular degeneration. There is also a lack of human clinical trials to prove that cannabidiol can effectively be used for AMD .

Macular degeneration is an incurable disease affecting the central part of the retina. People, especially older adults , are advised to consume supplements rich in specific vitamins and minerals to prevent or delay its onset.

Although there is no evidence that cannabidiol can improve vision, it offers antioxidant properties similar to these supplements that could be beneficial for eye health .

People need to consult a doctor first before deciding to take cannabidiol for any condition.

Cannabis and CBD oil: a new “old” friend in optometry

Optometric training requires learning about bones, muscles, neurology, and the vascular and other systems. But have you heard of the endocannabinoid system (ECS)?

If the answer is no, that’s not surprising.

Although the ECS is critical for human survival, 1,2 cannabinoid receptors weren’t identified until 1964, 1-4 when investigators were trying to locate where marijuana tetrahydrocannabinol (THC) interacted with the brain. It wasn’t until 1988 that the ECS was identified, and 1992 when it was officially acknowledged. 2-4

Humans operate on the parasympathetic and sympathetic system. The parasympathetic system operates under “normal” conditions.
When the body perceives it is under attack, neurochemicals trigger the sympathetic system, activating the “fight or flight” response. 5,6

The ECS, simply put, disengages the sympathetic system. It is responsible for bringing the body back into balance (homeostasis). 2,7 If it doesn’t, the body is faced with unresolved “danger” from the chemicals and processes that are designed to protect it. These chemicals cause inflammation and begin attacking and damaging the body, 7,8,9 which is then labeled as “such and such” disease. Our rampant, epidemic health problems are self-inflicted, 5,7,10 brought on by our diet, lifestyle, and technology. 7,10,11

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The ECS (Figure 1) is made up of 2 main receptor sites, CB1 and CB2. 2,4,7,10

CB1 sites are primarily in the brain, heart, and lungs, and modulate the immune response. CB2 receptors are primarily located in the lymph system, detoxification organs, and peripheral systems to break down and clear out the toxic immune system chemicals and debris. 1,3,7,14,24

The body produces its own chemical—anandamide, known as the bliss chemical—to regulate our systems via the ECS. 7,13,14 Unfortunately, in today’s high-stress environment, it can’t create enough to keep up with the demand. 10,14

Eating dark chocolate, exercising, or being “in the zone” are other ways to feed the CB1 and CB2 receptors. 7,14 Cannabidiol (CBD) was removed from livestock feed when it was made schedule 1 in 1941, so it has not been in the food chain for 80 years. CBD is nature’s external equivalent to supplementing the body’s anandamide shortage. 17,18,24


Cannabis

Technically, cannabis is not marijuana; nor is CBD. Cannabis is the botanical name for the common hemp plant, which has been cultivated for industrial purposes for more than 20,000 years. 15,18,24

The medicinal properties of hemp have been utilized for over 10,000 years. 15 The 2 main classes of cannabis are sativa, which is generally stimulating, and indica, which is generally calming. 16,18

Marijuana is a small subset of hemp that has been bred to produce more “high.” Hemp has over 400 different chemicals, with 100 compounds known as cannabinoids, each creating various effects. 16,18

CBD is one of the most prevalent cannabinoids in the hemp plant; it has the most profound, diverse, and beneficial impact. 16,18 The main takeaway is that cannabis is really just the hemp plant, and CBD is not marijuana.


THC

THC and CBD originate from the same compound and have nearly identical chemical structures (Figure 2). 16,22 Depending on the genetic strain, the hemp will have higher or lower THC and CBD levels. When the flower is beginning to bloom, however, growers must test the plants daily because the CBD in the plant will start to become THC. 16,22

At that point, the growers only have 48 hours to harvest their crop. The legal amount for THC to not be considered marijuana is 0.3%. 19,22

The CBD industry wants as high an amount of CBD as possible with the least THC possible. CBD’s profound effects on all bodily functions are not forced—unlike those of pharmaceutical agents—and nor does the chemical have their toxicities or unintended adverse effects (Figure 3). 20,21,24

As of February 2022, 37 states in the United States have legalized marijuana for medical use and 18 have legalized it for recreational purposes .20 The medical and recreational marijuana market is projected to be $30 billion in 2022. 21

Although marijuana still has legal hurdles to overcome, the CBD market is legal in all 50 states. 22 CBD is also available OTC and thus is free from FDA regulations and red tape. 22 The CBD market is projected to be $2 billion in 2022. 23

This projection will result in both good and bad consequences. Because cannabis has been outlawed as a Schedule 1 drug for 80 years, little controlled research has been undertaken and no distinction made between the effects of THC and those of CBD.

Medical benefits, risks

Much of marijuana use is for the high it produces, but there are some documented medical benefits. These include the relief of pain and nausea related to cancer treatments, aiding of sleep issues, reduction of posttraumatic stress disorder symptoms, easing of symptoms in those withdrawing from opioid addiction, and a calming of symptoms of various neurological conditions. 4,24

Unfortunately, according to more recent findings, marijuana does interfere with cognitive ability, 24,29 damages memory function, and destroys brain tissue. It also causes heart attacks—even in younger people with no underlying conditions—may have negative effects on genetics and pregnancy, and, if ingested by vaping or smoking, increases cancer risks. 24 Thus, marijuana is far from risk free.

Vision effects

Of more direct concern to optometrists are the negative effects of marijuana on the visual system. Both photopic and scotopic vision are impaired due to decreased macular and peripheral sensitivity. 24-35

Neurologically, vision processing is compromised, creating selective scotomas and interfering with one’s ability to navigate in the environment. 24,26-28,30,32-35

The eye is both a specialized neurologic receptor and a person’s primary connection to the physical world. It is important for optometrists to be aware of CBD, as eyes are packed with both CB1 and CB2 receptors.

Consider the major 5 medical conditions optometrists often encounter with when working with patients:

1. Cataracts 37

2. Glaucoma 38,39

3. Macular degeneration 41-43

4. Allergies 46

5. Meibomian gland disease 47

Although each is a separate condition, all have inflammation as the root cause due to the eye being threatened by the environment. 35,40 Many treatments are based on treating the symptoms or slowing the progression of damage by interfering with the ocular response process.

CBD works with the body’s natural system to decrease the inflammation process and restore homeostasis, avoiding the long-term results that define disease.

Peer-reviewed, evidence-based science is limited. However, I have heard anecdotally that some patients have experienced better vision with OTC supplementation of CBD and ocular nutraceuticals, backed by macular pigment ocular density (MPOD), optical coherence tomography (OCT), retinal photographs, and acuity. 43,44


Looking ahead

We have accepted that ocular “aging” conditions are normal, inevitable, and unstoppable. 45,57 Perhaps traditional medical treatments would be less necessary if we worked with the natural body system designed to minimize those issues.

Beyond ocular conditions, optometrists must step back and look at the larger medical issues facing humanity.

Obesity, diabetes, blood pressure, heart disease, cancer, Alzheimer disease/dementia, autoimmune conditions (lupus), rheumatoid arthritis, fibromyalgia, multiple sclerosis, neurologic disorders, depression, anxiety, panic attacks, migraines, attention-deficit/hyperactivity disorder, and concussions are all inflammation-related processes caused by an increased assault on our physical system.

This has overloaded the natural mechanism eyecare professionals were designed with to maintain health. Optometrists need to learn about ECS and CBD to augment their toolbox for taking care of patients’ well-being. 6,9,36,48,51,55,56,59-63

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