Randomized, Controlled Cross-over Comparison of Oral Cannabidiol to Oral Opioid for Postoperative Photorefractive Keratectomy Pain Control
In brief
Oral cannabidiol matches codeine-acetaminophen for post-PRK pain control
In a crossover trial of 35 adults undergoing bilateral PRK, 50 mg CBD twice daily gave the same average and peak pain scores as codeine-acetaminophen, with no difference in visual recovery. Patients reported slightly higher sensorium after their first CBD dose, but overall side effects were minimal, suggesting CBD as a viable opioid-sparing option in refractive surgery.
- Journal
- Journal of cataract and refractive surgery (Q1)
- Published
- 29 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Yujia Zhou, Kayla Swiatek, Andrew Nguyen, Sonal Tuli, Walter A Steigleman
- PMID
- 42524865
- DOI
- 10.1097/j.jcrs.0000000000002030
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 2 August 2026): CBD vs opioid for PRK pain control
Abstract
PURPOSE: To compare the safety and efficacy of low-THC oral cannabidiol (CBD) with oral codeine-acetaminophen for postoperative pain control following photorefractive keratectomy. SETTING: Academic outpatient clinical practice. DESIGN: Prospective, randomized, crossover, self-controlled clinical trial. METHODS: Thirty-five adults underwent bilateral sequential PRK, receiving oral CBD (50 mg twice daily) for one eye and oral T3 (codeine-acetaminophen 30mg-300mg every 4 hours) for the contralateral eye in a randomized sequence. Primary outcomes included pain and uncorrected visual acuity at month 3. Secondary outcomes included diary-reported symptoms, and patient-reported quality-of-life scores: Patient Reported Outcomes with LASIK (PROWL), Quality of Life Impact of Refractive Correction (QIRC), and Ocular Surface Disease Index (OSDI). RESULTS: Pain scores peaked on postoperative day 2 across both interventions with no significant difference in mean or maximum pain ratings (p = 0.538). Visual acuity improved significantly by POM3 (p < 0.001), with no treatment-related differences (p = 0.928). Sensorium was significantly higher when taking CBD for the first eye, and not the second eye, indicating first exposure effect (p = 0.035). Other symptoms and outcomes were equivalent between treatments. CONCLUSIONS: Low-THC oral CBD provides non-inferior pain control to codeine-acetaminophen following PRK with similar recovery outcomes and minimal side effects. Mild sensorium changes may occur in surgically naïve patients taking CBD. CBD may represent a viable opioid-sparing alternative in refractive surgery or acute pain management.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.