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The little fish jumped over, squatted beside the rock, and said happily, I found it, I finally found its old nest Then he went to pick up branches to pound the crab hole.Han Chang smiled and watched her busy.She wanted to remind her to be careful, but suddenly Xiaoyu pointed at something and whispered Sister Liu er, come and see, what is this , took a step forward, leaned 120ml CBD body oil in the direction of Xiaoyu s finger, and saw a mark carved with buy CBD oil capsules ebay a knife on the very secret corner behind the rock.

Han Chang stood up gently, looked at the distant place and took a deep breath, the storm had just begun, but she was not afraid.For him, how could she have to struggle once alex trebek CBD oil free sample A maid came over to invite Hanshang to Hongyeyuan for dinner.Perhaps Ye Xiaoyun already knew about Hongmei s trouble in the sideyard.Hanshang politely refused, and only said that he would stay here to take care of the green algae.In fact, it is more of a gesture, CBD oil for first responders a gesture of anger and resistance.Not long after, buy CBD oil idaho springs Mrs.

When there was a vague thought in those clear eyes, it seemed active CBD oil 120 mg particularly beautiful and moving, and even Han Chang felt sad when she saw it, and seemed to have some kind of resonance with it in the bottom of her heart.It s not related She couldn t help but repeat Peng Zheng any science behind CBD oil s words softly, how appropriate, isn t she and him the same, it s not related.Seeing that Hanshang was depressed, Peng Zheng waved his hand suddenly, as if to dispel the lingering sad atmosphere in the room.

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In addition to these days, he has repeatedly missed and pondered about her.He has a little understanding of her.Sure CBD Oil For Macular Degeneration enough, when he mentioned the word gentleman , Hanshang s heart was filled with endless The embarrassment.What an upright gentleman.Even though she knew everything how much CBD oil for kids clearly, she still had to pretend to be innocent to soften her heart.Her trembling hands suddenly clenched tightly.She walked out of the forest without thinking much.Lan Yufeng s eyes suddenly softened.

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Big Brother best CBD vape oil 1000 mg Lan wants to marry, but Big Brother Ye doesn t agree.Sister Liu er is so good, Big Brother Ye still wants to keep her at home as a younger sister, hehe At a critical moment, Ye Langqing walked into the room, his eyes widened when he said this Gently swept across the blue wind.Oh that s fine.Xiaoyu sighed like an adult, Sister Liu er is liked by so many people, how can I win over Brother Ye So I have to wait until I perform well in the school, and then let me Big Brother Lan took me to see her in Hongye Town After speaking, he sighed heavily, as if there were a lot of heavy worries, which made the three of them couldn t help laughing.

Ye Langqing oil massage melbourne CBD got the answer and was about to leave when he heard CBD oil for dogs with seizures amazon Lan Yufeng also stand up and leave.Jiang Bingyuan naturally didn t care about them, Top CBD Oil For Macular Degeneration he only cared about drinking and having fun with the women, and let them go.The two went out of Zhiyufang, and the refreshing night breeze made people feel at ease.The cold moonlight fell down, pulling the slender figures of the two to the elder elder.You benefits of CBD oil on your skin really still look like a buy CBD oil royal CBD CBD Oil For Macular Degeneration child, you can t see women Lan Yufeng looked up at the moon and smiled softly.

And now, where did he come out He was still flirting with Ye Hongmei just now, but when he turned his face, he was going to provoke this low key and cowardly Ye Hongliu again.What was he going to do Although there are ten million unwillingness in her heart, she can t refuse categorically, because she is Ye Hongliu, a cowardly and gentle Ye Hongliu.So Hanshang had to lower her eyebrows and make a grateful look, bowed to Lan Yufengfu, and said softly Hongliu thank you Lan for your kindness After speaking here, she stopped, She turned her eyes to Ye Hongmei s face, where she saw Ye Hongmei s blushing cheeks and vicious buy CBD vape oil locally eyes without any surprise, she shook her body lightly, and then said, However, Hong Liu can go back by herself, I don t dare to bother.

Even in a remote room like the second floor, he still couldn t stay away from the cheap and strong smell of fat powder.How did this old bustard manage this place Thanks to such an elegant name Zhiyufang In the darkness, a familiar voice sounded in a low voice, not unexpectedly but suddenly You re here It was often such a simple sentence.His existence was silent, but he best CBD oil for body aches was everywhere, and he was indeed a shadow warrior.Yeah.Hanshang responded softly, although there was no warm greeting, but his body and mind relaxed.

The steward left, and Ye Langqing turned around and entered the restaurant.Seeing that the two girls seem to be familiar with each other, they are burying their heads in the food, looking sweet.He smiled at Han Chang and said, Liu er, CBD hero oil amazon how about going to the shipyard with Big Brother after dinner Shipyard Han Chang s hand stopped slightly.The boathouse is a place of interest to her, and she has been there many times secretly, but this time, although she can go there openly, she has no interest.

Humph There are so many organs in this ghost place General Zhi Li watched the fireproof cloth beside his feet melted to nothing in an instant, a bit of best CBD oil isolates 2019 fear arose CBD oil augusta ga in his heart, and at the same time he was very resentful of the organs in this corridor, and couldn t help but feel He cursed harshly.Han Chang looked at him in a state of anger and despair.He should have been relieved in his heart, but for some reason he couldn t be relieved.She turned her head to look at the dark, headless corridor ahead, feeling as if she was slowly moving towards Huangquan Road.

Being an air bag for six years is enough The sky gradually darkened, and the remote courtyard was silent.After a day s rest, she was already full of energy.Hanshang called Chlorella into the room and pressed her in front of the dresser.I m going out tonight, so pretend to be me.She looked straight at Chlorella, not asking, not asking, but ordering.The green algae trembled slightly, revealing a hint of lack of confidence.But Hanshang didn t allow her to speak, Just lying on the bed, whoever came, just said that she was tired.

The people walking around were hot blooded men.She wanted to be frank with them and have fun with them, but she couldn t.She, a pretender born for a mission, is destined to live only in lies and deceit.In this life, she can only trust people where to buy CBD oil for pets like Duanmu Xuan at most.Those who trust do not rejoice, those who rejoice but CBD Bulk Oil CBD Oil For Macular Degeneration cannot trust CBD oil bulk CBD Oil For Macular Degeneration 051 Ye Tanjun Chengfu seemed to see Hanshang s abilify and CBD oil interactions disappointment, Lan Yufeng s eyes became deep, and he looked straight into her eyes, where , with only dark pupils, the fleeting emotions fell silent before he caught it.

Don t you think about it Yes.Maybe that fight was a scene from beginning to end.Hai Guangyao couldn t help but ask again.Lan Haohan s face was calm.He bowed his head in thought for a moment.He shook his head and said, Although I m not sure.But I can feel it from Hanshang s can dog od on CBD oil CBD Oil For Macular Degeneration attitude towards Duanmu Xuan.She didn t lie to me.She has a strange respect for me.Someone is in pain.Although I don t know who she is talking about.But I believe in the kind of sincerity she radiates from the bottom of her heart.

The cook who came to deliver the meal looked at Han Chang s eyes a little differently than before, she was so humble and even a little flattering.This is what the eldest young master specially instructed our kitchen to make for the third young lady The face full of fat smiled flatteringly.Han Chang smiled slightly, still saying It s hard work.Polite and distant.The cook didn t say anything, and left embarrassingly.After lunch, perhaps the concoction really worked, and I was sweating.

His deep eyes saw her eyes, serious and heartache.Why, you can get rid of this dusty place, but why don t you want to leave This was something he was always puzzled about, but he never wanted to get into it, as if he was afraid that if he got into it, he would find out what couldn t have her.reason.Hanshang forced a smile Isn t this a very good identity nordic oil CBD free sample You can get in touch with a lot of rich and unkind people, and you can also provide a good cover for my identity as a heroine.

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When she saw her, she was startled, so she was afraid first.Thinking like this, he couldn t help but smiled and said gently It s all right, CBD oil for penis enlargement it s just a measurement, it s where to buy CBD oil on long island inevitable to touch, sir, don t worry so much.But she is the young lady of the Ye family.The tailor wiped the cold sweat on his hands and breathed a sigh of relief.Rumors have it that the young lady of the Ye family has a bad temper.She seems very approachable today.But how does he know that Miss He is not this Miss After the tailor finished measuring his body, he followed the green algae to get the silk and satin.

In this way, Duanmu Xuan will become your shadow warrior.Of course she Will not blindly suppress, appropriate sweetness will make people positive.Sure enough, Chlorella s eyes were filled with joy, as if that moment would be fulfilled in the near future.The mood is different, and the attitude is naturally different.She hurriedly and meekly took the empty cup in Hanshang s hand and asked slightly flatteringly, Miss, do you want another drink Hanshang shook her head, closed her eyes and lay down again.

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After speaking, he turned around gracefully and walked out the door.Yun Changling froze for a moment and then followed, and when they left the yard, she couldn t help frowning and asked, Don t you think what that CBD oil uses Lady Ye Jiao said is a little strange Lan Yufeng smiled lightly So what, Lang It s good to clear the letter.Of course, Ye Lang s clear letter is naturally not good, when he returns, he must let Lan Fan investigate the origin of this night s charming girl nnsp 054 They set off early the next morning after having a good identity and background, along with Yun Changling.

Shi Chunsheng finally couldn t bear it any longer, and his body began to twist and become irritable.At this time, Lan Yufeng said lightly Tell me, why do you want to kidnap the girl Shi Chunsheng s face was stunned, and then he shook his head sharply The villain doesn t really want to kidnap the girl, really not.People don t know what happened, and suddenly He looked anxious, not like a lie, a strange light flashed in Lan Yufeng s eyes, and then asked, Where did you go before Han Chang s heart skipped a beat, and she felt an inexplicable guilt.

That Duanmu Xuan was injured so badly that day.She suffers.If she is indifferent, is she still worthy of your love Lan Yufeng was speechless.suddenly felt.My father s words also make sense.When I was on the boat.I once asked her why she wanted to save me.She replied that it was to make a person no longer suffer.The person she said was not who you were.Lan Haohan continued.Lan Yufeng s body trembled upon hearing this.Emotions that have been accumulated in the body for a long time.

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Although this was a good thing for her, it also cost her an opportunity, an opportunity to meet the county chief.However, it doesn t really matter whether we see it or not, because at such a grand banquet, what secrets would the men talk about She, there will be many opportunities to inquire about CBD Oil For Macular Degeneration secret matters.After lunch, I slept well, and no one disturbed me.In the Top CBD Oil For Macular Degeneration evening, the people in the kitchen brought dinner again, and Han Chang was too happy to go out.Thinking of Ye Hongmei and Wu Yuegui s mother and daughter s contempt for arrogance, she hated it so much that she was afraid that one day she would no longer be able to play the role of the airbag.

After all, it is the descendant of his Red Leaf Villa, and with just a little embellishment, it immediately has a different temperament.Ye Langqing was delighted to see it, and said happily I was still thinking about what kind of clothes Liu Er should wear, but now it seems that I don t have to He stood up and pulled Hanshang s soft weed, Let s go Where are you going Han Chang was slightly stunned.Ye Langqing smiled brightly There is a guest today, and the villa is hosting a banquet.

Wouldn t it be more convenient to play it Ye Langqing said, his eyes glowed with brilliance, I am proficient in shipbuilding, and I want to make violins and ships.There is also a co worker s place, I am willing to try it for the girl, I don t know what the girl thinks That would be the best, but Han Chang is cannabis oil the same as CBD s eyebrows were slightly hesitant, There are only two days until the fifteenth., can the young master be in time As long as the girl whole foods CBD hemp oil gives the drawing, I will be able to do it Ye Langqing s voice became clear, with undisguised joy.

The county chief is the australia CBD oil largest official in Zhenhai County.There are so many things to deal with every day, where can is CBD oil legal in wyoming there be black seed CBD oil more stay in the Hongye Villa in the sky But at least it s time to have lunch before leaving.If you leave in the morning, let it be Outsiders thought that our can CBD oil cause constipation Red Leaf Villa was not very good at hospitality Hanshang raised her lips slightly and said innocently, but the exploratory gaze hidden in the bottom of her eyes was locked on Ye Langqing s face without any how to make CBD oil dog treats trace.

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076 A group of people swarmed in the house where Lan Yufeng was embarrassed and alienated.The doctor accompanying the boat was dressing his wound, the maid was passing him water, and many more.The subordinates are praising the heroism of the young gang leader.Lan Yufeng s face was indifferent, as if the thrill just now CBD oil gold formula oral applicator was not worth mentioning, and the tone of Yu Lin s commander was as calm as ever.Let them stretch their sails to the max and return at full speed.That shark s blood is likely to attract other sharks, so let s be careful Yu Lin s face sank, and CBD Oil For Macular Degeneration he came out in response.

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Duanmu Xuan watched CBD oil edible CBD Oil For Macular Degeneration her rubbing, smiled lightly, and said in a soft and gentle voice Why did you wake up so quickly When you fell natures sensation CBD oil asleep, you still frowned, what troubles you Han Chang sighed and didn t answer, His smile was CBD oil instead of alcohol a little alienated, and his pretentious gentleness was a little too far, so that she could easily see the pain in his heart.You shouldn t be following me anymore, she said.She couldn t relieve the pain in his heart, let alone the depression in her own heart.

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The matter of threatening the general was resolved on a very small scale, and no one knew about it except duckweed.Hanshang stayed on the island and lived in the best room.Duanmu Xuan was also forgiven of all his sins.Others on the island were very surprised.Although there were doubts in their hearts, they were polite to Hanshang., No man with a heart dared to take a step closer to Hanshang.On the surface, the general was very happy about Hanshang s return, and even held a banquet for her, but Hanshang knew that he had already saved the heart to get rid of her, but there was one more important thing that needed to be taken from her.

Han Chang exclaimed Oops and fell into Jiang Bingyuan s arms.Let go of me, Lord Jun Cheng She whispered, her beautiful eyes suddenly covered with a thin mist, she shook her head gently, loosened part of her bun, and the dark ink brushed her cheeks.It s hard to catch, how can I let it go Jiang Bingyuan smiled and put a mouth that smelled of alcohol on Hanshang s face, the rotten breath almost made Hanshang vomit out.Han Chang pushed gently, her cheeks blushing, as if she could not break free from Jiang Bingyuan s clutches with all her strength, so anxious that two lines of clear 500mg CBD oil near me tears flowed down her cheeks.

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Speaking of which, he snorted lightly, This is what I said, the trick of Yin damage.After Duanmu Xuan finished speaking, his body suddenly began to tremble, and his face changed.Tired, Hanshang hurriedly hugged him.Duanmu Xuan s teeth clucked, and he said intermittently CBD oil ingredients in Hanshang s arms I have internal injuries, and now the poison has developed, and I will die in a moment No You can t die Hanshang shook his head violently Duanmu Xuan covered her mouth gently, and said slowly, Now listen to me say, what I want to tell you is that you were brainwashed when you were adopted by the general, so highline CBD oil you don t I remember that I once owned that jade pendant.

Han Chang nodded with a proud look That s natural, people like you who can t do anything, of course you need to report.She turned around and bowed, and slowly lifted Duanmu Xuan, who had recovered slightly, and said lightly, We can t run anyway, so I don t mind CBD full spectrum oil CBD Oil For Macular Degeneration waiting for two more best daily CBD oil days.But don t forget, we are in the territory of the Yangming Dynasty.The man in black waved his hand, and everyone else retreated, leaving only duckweed in the room.Hanshang helped Duanmu Xuan to lie down on the bed, and turned to look at duckweed You helped us before.

So, all he could do was leave and leave his sister alone for a while.Looking at Ye 7th letter CBD oil Langqing s slightly dejected back, Han Chang felt a touch of melancholy in his heart.It s not that she didn t see his open and closed lips, buy pure CBD oil how long does CBD oil take to work CBD Oil For Macular Degeneration he tried to comfort her, but didn t know where to start.She always had those sadness in the corner of her mouth, just wished he could leave sooner.Because she is CBD oil for eye inflammation too tired and wants to rest.It s just that after staying in the Lan family mansion for a few days, can t another name for CBD oil you adapt to such a disguised life The sadness at the corner of Hanshang s can CBD oil CBD Oil For Macular Degeneration lips suddenly turned Top CBD Oil For Macular Degeneration into a faint mockery, mocking his own wishful thinking.

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How weak is this comfort In a place where there are prostitutes, can you CBD oil for eczema still not sacrifice Han Chang restrained her self deprecating smile, and her thin lips pursed lightly in response Yes, I will follow my orders.The pain in Top CBD Oil For Macular Degeneration her eyes disappeared best CBD oil forums in an instant, and indifference and calmness came in exchange.Her restraint and forbearance would only make his heart hurt even more, and Duanmu Xuan almost wanted to go up and take her into his arms.However, it can hempworx full spectrum CBD oil 500 t.He 50 CBD oil for sale is just her shadow warrior, just look at her from a distance, no matter what she will give for the general s great cause, she will always be holy in his heart Duanmu Xuan thought, and let out a long sigh from the bottom of his heart.

Han Chang tilted his head to look at him, and when he saw his gentle eyes staring at him, he quickly lowered his eyelids.No longer afraid of identity being discovered, but panic for no reason Last night, she was disappointed by the panicked eyes that didn t match his appearance, but today s elegant clothes are what she expected Why is this so I should hate his cunning and camouflage, but why are you panicking for him The peaceful heart lake seemed to be suddenly stirred by the thrown stones, causing waves of ripples.

Tell me.Are you still doing something But she didn t tell me.Duckweed was stunned.Then her face changed slightly.Hanshang saw her look like this.Her heart suddenly became clear.Then she became angry.It s for me to hide it from me.Duckweed lowered her head and said nothing.Where is Duanmu Xuan.You tell me what he s best starter kit for CBD oil pen doing.Hanshang asked sharply. Chapter 168 Forcing duckweed how often do you take CBD oil to just bow her head and not answer.Han Chang was in a rage, trembling all over, but what ananda CBD oil 300 dosage she said to Duckweed was extremely cold So, you are not going to tell me Duckweed looked up at her, her eyelids when to take CBD oil for sleep CBD Oil For Macular Degeneration trembled slightly, and she wanted to speak again.

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Duckweed then raised aromatic infusions CBD oil her eyebrows and smiled Then Alright, I ll go tell him now, Ye Jiao Niang has promised him to play music for him alone tomorrow night.Han Chang felt a thorn in his heart suddenly, giving birth to a faint tingling.Well, you go.She replied softly, but felt that she had used a lot of strength to say these words.Duckweed turned around and went out in response.Hanshang walked back to her room and sat down in front of the bronze mirror, staring blankly at the beautiful appearance in the mirror.

How to do how to do At this moment, the sound of messy and vain footsteps CBD oil shop bristol suddenly approached, and the strong smell of alcohol hit the nostrils.Hanshang turned his head to look, and saw that Jiang Bingyuan s gorgeous satin robe had been deformed a little under the moonlight, humming a little song with a shiny face, and was walking here with a bit of wine.A flash of light flashed in his mind, and a strange smile appeared on the corner of Han Chang s mouth.She quickly took off the black adhd and CBD oil reddit clothes outside, and the thin white middle clothes inside were exposed to CBD oil for sale south africa the night.

Your ability to complete my task is the best reward for me Speaking of which, he let go He eased his tone and coaxed, Of course, if the task is not completed, I won t blame you, as long as you can keep working hard in the future Didn t you say you need help You need Duanmu Xuan, don t you I can send him to you again, but he s already blind in one eye, so I m afraid it won t be of much use Han Chang was not moved by his gentle tone, but replied coldly It is not very useful, I will judge by myself, what you are looking for, I am afraid that few people in the world have clues, and I am one of When Han Chang said this, she could clearly see the ruthlessness in the general s eyes.

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She looked at his resolute profile, and a terrible thought came to her mind.In the future, if he knew that the woman was a disjointed person, would he resolutely give up that relationship Yes, it will He is very determined and will not let his children s personal affairs hinder his country s righteousness Thinking of this, her heart felt as if it had nuleaf naturals CBD oil for dogs fallen into an ice cellar, and it was completely cold There was a commotion on the boat, Lan Yufeng turned to take a look, the serious expression just now became vivid and lovely.

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When gently opening the door, Ye Langqing was holding a water glass and gently held it to Ye Jiao Niang s lips.The tender eyes in his eyes were undisguised, but they stabbed Lan Yufeng s heart slightly.Miss Ye, is she all right Lan Yufeng pulled out a smile at the corner of his mouth, trying his best to hide his emotions.Although he was asking Ye Langqing, his eyes were fixed on Han Chang s face.Contacting Lan Yufeng s gaze, Hanshang s heart trembled slightly and her eyes lowered.

The next day, a hurried knock on the door woke Han Chang from her sleep, and Chlorella s thoughtful voice sounded outside the door Miss, are you going to Hong Ye Yuan to serve tea to the master and wife After a few days, she also Gradually I understood a little of Hanshang s mind, and I knew how to speculate.Han Chang does CBD oil help with cramps quickly got up and opened global green CBD oil CBD Oil For Macular Degeneration the door.Green algae was holding a pot of warm water for the first time in the world, and she looked like does CBD oil affect sperm count a CBD Oil For Macular Degeneration close fitting maid.This kind of green algae made Han Shang a little uncomfortable.

Sister in law Zhu opened the box The eldest young master bought this specially in the town, and it is for the third young lady alone.It can be seen that the eldest young master loves you so much After he finished speaking, he waved his hand and signaled to the servant general.Jewelry and cloth were sent to Hanshang s house.Hanshang s dark eyes were suddenly covered with a thin layer burnt CBD oil CBD Oil For Macular Degeneration of water mist, and there was a slight tremor in his voice Big brother treats Hongliu like this, Hongliu doesn t know why it s a reward Speaking of the back, there was a hint of A few traces of sadness.

When the Governor arrives, he must prepare the best courtyard, independent and luxurious.Hanshang nimbly climbed a tall sonoma valley CBD oil tree in the dark, hidden among the branches and leaves at the top of the tree, and looked in the direction she remembered.I saw a small courtyard with a glazed tile roof.From a distance, it is faintly visible that the lights inside are bright.Jiang Bingyuan himself and his family are watching the play in the front yard.It is quiet and gorgeous here, and there are people there.

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Change in Refractive Error Associated With the Use of Cannabidiol Oil

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Cannabinoid (CBD) products have gained popularity since their legalization in 2018, causing a plethora of unregulated CBD products to be sold in the United States. These products are available in various combinations for topical and oral consumption, claiming credit for potentially improving various diseases. In this report, we present a newfound case reporting a shift in refraction that may be associated with the regular use of CBD oil supplements.

A 57-year-old woman with a history of diabetes mellitus type 2, hyperlipidemia, obstructive sleep apnea, with no change in medications, diet, or lifestyle was found to have a hyperopic shift in vision with the recent daily addition of CBD oil intake.

This case report highlights the possible association of CBD oil and vision changes after regular consumption of CBD oil in an otherwise stable patient. Further study is required to understand the mechanisms of CBD oil-associated shift in refractive error. Because the patient is diabetic and the refraction shift was hyperopic, other etiologies, such as un-noted lenticular change, cannot be ruled out. CBD products are unregulated and marketed in many mixed forms, and thus can cause unforeseen effects on susceptible individuals. This warrants Food and Drug Administration (FDA) regulation of such products and extensive research before considering them for therapeutic usage.

Introduction

Cannabis, or marijuana, has been utilized in psychogenic therapy for hundreds of years. Over the past few decades, it particularly has a newfound use in pain medicine, neurology, oncology, gastroenterology, and ophthalmology [1-2]. Recently, cannabinoid (CBD) oil has been immensely used as supplements and in beverages after the passing of the Hemp Farming Act (HFA) in 2018, which legalized hemp-derived products in the United States. This has allowed commercial companies to produce and sell unregulated CBD oil products without US Food and Drug Administration (FDA) approval. Each product of CBD is potentially unregulated as an uncontrolled substance with varying concentrations, variance in the quality of hemp varieties, and lipid oxidation profiles [3]. Without regulation and medical guidance, CBD oil products can cause severe side effects [4]. We present an isolated case of a patient who reported gradual improvement in myopic vision after starting cannabidiol (CBD) oil for the past few weeks and reversal to original myopic refraction after the discontinuation of CBD oil. To our knowledge, this is the only case report that presents a hyperopic shift in association with cannabidiol oil intake in the English language ophthalmic literature.

Case presentation

A 57-year-old, white female presented to the optometry clinic with eye strain and a gradual decrease in her vision for the last three weeks. She reported her eye strain was somewhat relieved after she removed her glasses. Her medical history was remarkable for obstructive sleep apnea, hyperlipidemia, and polyneuropathy secondary to continued uncontrolled type 2 diabetes (most recent hemoglobin A1c = 12.8%), osteopenia, and restless legs syndrome. Her social history included cigarette smoking (seven cigarettes a day with a five-pack-year history). She denied the use of alcohol or recreational drugs. Her ocular history pertaining to trauma or any surgery was negative. Additionally, she noted having no other symptoms such as headache, dry eyes, double vision, vision loss, spots, or threads in her vision.

On examination, her visual acuity (VA) with her habitual glasses was 20/60 in the right eye (OD) and 20/70 in the left eye (OS), pin holed to 20/40 OD and 20/40 OS. The pupils were round and reactive to light OU, with no relative afferent pupillary defect. External examination, extraocular muscle movements, and counting finger visual field tests were normal. Her intraocular pressure was 16 mmHg in the right eye and 17 mmHg in the left eye, measured with a tonopen. The dilated fundus examination revealed rare cotton wool spots, microaneurysm, dot-blot hemorrhages, and vascular attenuation consistent with moderate, non-proliferative diabetic retinopathy in both eyes without any signs of macular edema (Figure ​ (Figure1). Her 1 ). Her optic cups appeared normal with no signs of glaucoma. Given her decrease in vision and clinical presentation of non-proliferative diabetic maculopathy, we decided to run a macular optical coherence tomography (OCT) scan (Figure ​ (Figure2). 2 ). The fovea showed a normal contour, no central macular edema, and an average central retinal thickness of 275 µM OD and 273 µM OS.

Figure 1

Color fundus photographs of the right eye (A) and left eye (B) with non-proliferative diabetic retinopathy

Cotton wool spot (thin arrow), dot blot, and exudates (thick arrow)

Figure 2

Fovea shows normal contour with no central edema; average central macula thickness of 275 µM OD and 273 µM OS

On refraction, her manifest refraction had shifted from her habitual of -2.25 D sphere to -0.75 D in the right eye and from a habitual of -2.00 D to -0.75 D sphere in the left eye. Her new corrected VA in the right eye was 20/25 and 20/25 in the left eye, and a new pair of prescription glasses were made. This new information of hyperopic shift led us to systemically review her medications for possible associations.

Her medications included multivitamins, dulaglutide, canagliflozin, sitagliptin-metformin, lisinopril, gabapentin, pramipexole, clotrimazole-betamethasone, cyclobenzaprine, glucosamine sulfate, zolpidem, cetirizine, ranitidine, and magnesium oxide. In addition to the above, over the past eight weeks, she had started taking 750 mg of peppermint-flavored Full Spectrum CBD Oil (HempWorx, MyDailyChoice, Las Vegas, Nevada), 12 drops twice a day for restless leg syndrome. The patient reported having improved sleep but associated gradual blurry vision which made her visit the optometry clinic.

At the three and six-month follow-ups, the patient’s refraction was re-assessed, and her improved VA remained stable with no report of blurry or worsening of vision, headache, or eye strain. The patient continued to take CBD oil regularly as before and claimed her improved vision to the intake of CBD oil. The patient additionally reported no significant change in diet, lifestyle, and medication and reported her new glasses to be “perfect.” At the nine-month tele-visit follow-up, the patient ran out of CBD oil and thus had to stop taking CBD oil for three to four weeks. Within three weeks of stopping the CBD oil, the patient again noted a gradual worsening of her vision. The patient tried her old prescription lenses with -2.25 OD and -2.00 OS refractive error correction and reported seeing clearly. She had reverted to her original myopic state after stopping the CBD oil.

Discussion

Based on the patient’s history and ocular examination, there is a clear hyperopic shift in the patient’s refraction after initiation of the CBD oil supplement and its reversal after stopping the CBD oil. Her refractive error remained unchanged while she was on the CBD oil supplement and attests to the use of CBD oil regularly as she finds relief from her restless leg syndrome. Possible etiologies of her refractive shift include the patient’s status of diabetes mellitus type 2, medication history, and her recent use of CBD oil [5].

Based on the exam and imaging, our patient had classic diabetic retinopathy (last HbA1C 12.8%) with no significant macular edema. Myopic shifts in vision are reported in about 4% of the diabetic patient population, however, hyperopic shifts are reported even less often. Myopic and hyperopic shifts have been traditionally thought to be due to hyperglycemia and hypoglycemia, respectively, but recent studies have suggested hyperopic shifts can also occur due to hyperglycemia [6]. The hyperopic type of refractive shift in an uncontrolled diabetic patient has been mostly attributed to the changes in the refractive index of the lens due to fluctuations in water distribution [7-9]. In the current patient, the timing of the onset of refractive change, along with her chronic state of uncontrolled diabetes (based on her last three years of high Hb A1C numbers), is unlikely due to her hyperglycemia, especially when associated with the change in vision over three weeks of time after the initiation of CBD oil. Interestingly, her refractive shift was stable while she was on the CBD oil and reverted to her original myopia after she stopped taking the CBD oil.

The association of vision change after the start of the CBD oil cannot be ruled out as one of the plausible causes. The authors are aware that this is an isolated case report where the patient clearly related her gradual change in vision after starting the CBD oil drops twice daily for six weeks. While the mechanism by which CBD oil affects refractive error is still an area for further exploration, CBD has been shown to regulate blood flow in retinal vessels and help in reducing neurotoxicity, oxidative stress, and blood-retinal barrier breakdown. The possible inhibition of p38 MAP kinase may also be a possible theory for the hyperopic shift [10-12]. Effects of cannabinoids on the anterior segment of the eye are also multiplex, and some studies indicate decreased corneal endothelial density [13]. Further studies will be needed to assert the findings from this isolated presentation of the case to better understand the role of CBD oil in refractive errors of the eye, especially in a diabetic condition.

Conclusions

We present a case where a woman taking CBD oil orally for six weeks on a regular basis was found to have an improvement in myopia. In addition, her hyperopic shift reverted to her original myopic vision once she stopped taking her CBD oil. To our knowledge, this is the first case of CBD oil in association with a hyperopic shift. The mechanisms by which her VA improved are uncertain and can vary from possible corneal changes to retinal vasculopathy. Hyperopic shift due to her diabetes and antihistamine medications are a possibility, although unlikely, due to her established disease and chronic medication use. There is no previous case report of such an association in hyperopic shift and no prior head-to-head study looking at specific types of CBD oils and other forms of cannabinoid products. This novel isolated incident between CBD oil and change in VA requires additional, controlled, blinded research for further applicability.

Notes

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.