COA Vision Blog


September 28, 2017 Uncategorized

With the talk of cannabis constantly growing, we get a number of patients who ask about marijuana and glaucoma. We would like to shed some light on the reality of the situation and have asked Dr. Orlando, founder of Columbus Ophthalmology Associates and expert cataract surgeon to shed some light on the reality of using marijuana to treat glaucoma.

But first, let’s start with what is glaucoma?

Glaucoma is a common sight-threatening disease that can cause damage to the optic nerve damage, the delicate cable-like structure that connects the eye to the brain. Most often, the damage is a result of chronic high pressure within the eye that slowly destroys the nerve fibers from the inside of the nerve outward. The loss of optic nerve fibers is not reversible but at detection and with treatment, the progression of the disease can be stopped.

 

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Now that we’re clear about glaucoma, we’ve asked Dr. Orlando to give us a glimpse of what he shares with his patients about glaucoma and the use of cannabis.

“Last year Ohio voted to legalize medical marijuana and almost immediately patients began to ask if it would help them with their glaucoma. So far, Ohio has not determined what medical conditions and in what clinical circumstance cannabis can be used. However, the drug has been studied for many years by ophthalmologists as public opinion has more or less approved it’s use for glaucoma. But the scientific reality is that it does not really work as treatment for this potentially blinding disorder. First of all, one must understand that glaucoma is a very multi-faceted and challenging disease that can present in a variety of ways. Basically, the internal pressure of the eye damages the delicate optic nerve which connects the eye to the brain where images are created. Eye doctors measure this pressure as part of their routine eye exam and look for elevation that is above the normal of 20mmHg. However, damage can occur even with pressure readings lower than 20 and so the optic nerve itself needs evaluation with a variety of tests that can pick up early signs of damage. When diagnosed, the glaucoma specialist will set a “target pressure” and begin the most appropriate treatment to lower the readings to that point. Follow up visits are required in order to make sure there is no further damage to the nerve with the initial medical therapy. In some cases, a special laser known as the SLT will open the internal canals and allow the pressure to drop if topical drops do not control the pressure readings at a safe level. In extreme cases, microsurgery will create a drain from inside to drop the pressure and prevent further damage.

Scientific research on the use of cannabis for glaucoma treatment has been done for over 30 years. Initial studies done with patients smoking the drug found pressure readings that dropped around 25% but the effect lasted only 2 to 4 hours. Other studies with oral administration of cannabis extract also showed only a short time frame for lowering of the intra-ocular pressures. Some case reports have showed variable response to the drug in lowering pressures and so the overall consensus is that cannabis is ineffective for long term treatment of glaucoma. There are far more proven effective therapies and the American Glaucoma Society has stated there is no form of cannabis that is recommended for treatment of this disease.  The University of Mississippi is currently the only approved site for cannabis research and we will await further studies to see if this can be an effective adjunct to our current treatment options.”

Hopefully this update from Dr. Orlando has helped shed some light on the use of cannabis for the treatment of glaucoma. If you are suffering from glaucoma and would like to speak with a specialist, please call our offices and we will be happy to assist you.



September 15, 2017 Uncategorized

I had the great privilege in being trained in ophthalmology by William H. Havener, M.D. back in the early 1980’s. Dr. Havener was a world class ophthalmologist and chairman of in the Department of Ophthalmology at Ohio State, now known as the William H. Havener Eye Institute. He taught me many things, from the proper way to use the surgical  microscope to creating a proper cataract incision. But more importantly, he tried to give all those that trained under him a sense of how to communicate with our patients in order to provide the best possible result for their problem. There are times, perhaps, that we do not meet that expectation but do all we can to ensure that we remain first and foremost our patient’s advocate, no matter the situation.

From the standpoint of the communication, he always told us that history taking is paramount so we can elicit enough detailed information to help arrive at the correct diagnosis. Likewise, he emphasized that we should speak in plain language so our patients clearly understand the situation. With proper give-and-take interaction, both the patient and the physician reach a level of acceptance and trust so that any unusual details in the history are revealed.

As a physician, it is my job to determine what is wrong and carefully assess during each step of my examination where the nature of the disease is present. There are many aspects to the visual system that can affect our sight and our years of training allow us to go through a wide spectrum of choices, eliminating unlikely possibilities and carefully weighing the pros and cons to come to just one or two choices. At that point, we must then convey to our patients in a manner that allows them to be assured what we are stating is true and ensure we both have an understanding of their symptoms and the long-term management of their problem.  All surgeons want to be helpful and assist their patients in the best manner possible. Sometimes this may mean a referral to an outside specialist or to someone within our own practice that works exclusively in the management of their condition. I have always tried to put any unwarranted fear aside for our patients and help them understand that there are many possibilities in the treatment for their particular problem. This is the great art of medicine and we take that trust that you place in us very seriously.

This type of communication Dr. Havener used to call, “reassure therapy”. It was not simply a matter of saying “Oh, do not worry”, as that never works. What I will always try to do as a physician is to give you an honest and thorough analysis of your clinical circumstance and stress the positive aspects that can be found with each condition.

– Dr. Richard Orlando

Dr. Havener




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