Discussion
Although this is a case study, we believe that these results reasonably indicate support of the hypothesis that oral THC and smoked cannabis may improve night vision sufficiently to merit additional investigation. Furthermore, this pharmacological effect appears to be cannabinoid-mediated. In the Jamaican study (West, 1991), it was hypothesized that non-psychoactive cannabis components were responsible for the putative improvement in night vision, and that the sites of action were the adrenoreceptors of the ciliary epithelium. Previous experiments ( Weil et al., 1968 and Brown et al., 1977) refute a mere pupillary dilation effect of cannabis. Given the marked paucity of cannabinoid type-1 (CB1) receptors in the striate cortex of Brodmann’s area 17 (Glass et al., 1997) and its relative greater abundance in the human retina ( Straiker et al., 1999; Yazulla et al., 1999 and Porcella et al., 2000), the latter seems the more logical site of mediation of this improvement in night vision. Specifically, the scotopic benefit in night vision would support a stimulatory effect on visual rods. Straiker et al. (1999) have demonstrated a rich CB1 expression in rod spherules, and a modulation of voltage-gaited L-type Ca++ channels in the axon terminals of retinal bipolar cells, with the suggestion that cannabinoids modulate glutamatergic synaptic transmission. This neuromodulatory effect was further supported by the identification of the endocannabinoid, 2-arachidonyl glycerol (2-AG), in the retina. In analogous fashion, another group (Bisogno et al., 1999) has demonstrated the biosynthesis and inactivation of the endocannabinoid arachidonylethanolamide (anandamide) in bovine retina, providing further support for the concept that this system may fulfills a neuromodulatory role in scotopic sensitivity.
There may be practical applications for these findings in clinical ophthalmology beyond improvement in night vision or treatment of nyctalopia (night blindness). An interesting anecdotal phenomenon of improvement in visual acuity in retinitis pigmentosa (RP) after smoking cannabis was recently published (Arnold, 1998), but seemed to be strain-specific with respect to the cannabis employed. Further study will hopefully be achieved employing standardized oro-mucosal or vaporized cannabis extracts ( Whittle et al., 2001) in a totally objective double-blind experiment in normal and RP patients utilizing electroretinography (ERG) to assess this hypothetical application, and whether significant therapeutic benefits are possible at a dosage that is not subjectively too intoxicating to the subjects. In this manner, the relative contributions of THC, CBD, other cannabinoids, and even essential oil terpenoid components ( McPartland and Russo, 2001), to the observed effects, could be scrutinized and quantified.
The neuroprotective and antioxidant effects of THC and CBD (Hampson et al., 1998) may have additional applications in other eye diseases such as senile macular degeneration, or in the vascular retinopathy of glaucoma ( Jarvinen et al., 2002), where similar claims for therapeutic clinical cannabis are abundant.