Glaucoma

INFORMATION FOR WOMEN WHO HAVE GLAUCOMA DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is glaucoma?

Glaucoma is a condition of the eye whose main feature is damage of the optic nerve, usually due to the pressure in the eye being abnormally high. If untreated, this can lead to blindness; in fact, glaucoma is one of the principal causes of blindness in developed countries. Since glaucoma is a common condition and can occur during young adulthood, and especially middle adulthood, it can happen during pregnancy, particularly in pregnancies of older mothers. There are many types of glaucoma, but the most common type does not have many warning signs and develops gradually. However, it can be recognized early by an eye care professional in people who go regularly for glaucoma screenings.

How common is glaucoma during pregnancy?

Glaucoma is particularly common in adults above 40 years of age, but it is a common disease that can occur at any age, and so it becomes a serious possibility during ones 30s. Consequently, about 2-3 percent of pregnant women over age 40 have glaucoma.

How is glaucoma diagnosed?

Glaucoma may not be noticed until the disease is advanced. On the other hand, it can be detected early through routine exams from an eye care professional, meaning an ophthalmologist (a medical doctor who holds an MD or DO degree and who has done special training, after medical school, in eye diseases and eye surgery) or an optometrist (a non-surgical doctor who went to graduate school specifically to treat eye conditions and holds an OD degree).

Whether by an ophthalmologist or an optometrist, diagnosis of glaucoma is achieved through the finding of various signs obtained on a variety of tests. One type of testing, called tonometry, checks the pressure inside the eye when a puff of air is shot at the eye. Another type of testing is called ophthalmoscopy and uses light and magnification to give the doctor a detailed look at your retina and optic nerve. This can reveal damage resulting from increased pressure. There is also visual field testing to assess whether you are missing parts of what you are supposed to see. If any of these tests are abnormal, the doctor will want to proceed to other tests to assess what type of glaucoma you have.

Does glaucoma cause problems during pregnancy?

One common type of glaucoma, called open-angle glaucoma typically shows up with patchy areas of blindness in your central or peripheral (side) vision, often in both eyes. If the disease is advanced, the person can experience tunnel vision. Another form of the disease, called acute angle-closure glaucoma, comes with a variety of symptoms, such as blurred vision, halos in the vision, red eyes, eye pain and headache, and nausea and vomiting. Interestingly, the pressure inside the eye actually drops during pregnancy and remains reduced in the weeks following delivery. Theoretically, this drop in pressure should protect pregnant women who normally have borderline high eye pressure or who may be experiencing a slow onset of glaucoma. However, it is not yet clear whether the theoretical benefit actually gives pregnant women protection.

Does glaucoma during pregnancy cause problems for the baby?

There is no direct impact on the baby. However, any vision loss can incapacitate you and make you more susceptible to falls and other injuries that could harm the baby.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the glaucoma
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat glaucoma during pregnancy?

Glaucoma is treated with several families of medications. The main such medication families are called beta-blockers, alpha agonists, prostaglandin analogs, and carbonic anhydrase inhibitors (CAIs). Most medications are given as eye drops, but some are given as pills.

Who should NOT stop taking medication for glaucoma during pregnancy?

No one who is prescribed medication for glaucoma should stop taking it during pregnancy. However, if you are found to have slightly elevated pressure in the eyes near the beginning of pregnancy, and there are no signs of damage to the eye, your eye care provider might want to monitor your pressure to see if it decreases throughout pregnancy.

What should I know about choosing a medication for my glaucoma during pregnancy?

Beta-blocker medications are typically avoided or given with extreme caution, in cases of certain diseases, especially asthma and some other conditions of the lung, but overall they are considered relatively safe for the developing baby in a pregnant mother using the medications for glaucoma. There also are certain beta-blockers that are considered safer than others, and your eye care provider can select the medication appropriately. With certain alpha agonists, one called brimonidine, in particular, there is concern about possible dangers to the fetus or newborn, but there are other alpha agonists that are thought to be safer. The most effective glaucoma medications are the prostaglandin analogs, but there is some concern, based on laboratory animal studies, that they may present a risk to the developing baby, but many more studies are needed, so generally, these drugs are given during pregnancy but with extreme caution. As for the CAIs, there is concern about possible effects on the fetus, but studies are ongoing.

You may find Pregistrys expert reports about the individual medications used to treat glaucoma here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my glaucoma when I am breastfeeding?

The American Academy of Pediatrics (AAP) approves all beta-blockers and most CAI medications for treatment of glaucoma in nursing mothers. The alpha agonist medication brimonidine can enter breastmilk and possibly cause harm to a nursing infant. Thus, even if a woman is taking brimonidine during pregnancy (when it is safe), she should stop taking it at the time of labor, if she is planning to breastfeed, and replace it with a different drug. There is some concern, and a lot of uncertainty, about the CAIs brinzolamide or dorzolamide regarding their effects on nursing infants, so these should be avoided and other drugs used instead. While some laboratory animal studies have raised concern about the CAI acetazolamide, it is approved by the AAP for use in nursing mothers.

What alternative therapies besides medications can I use to treat my glaucoma during pregnancy?

Surgical procedures are available for treating difficult cases of glaucoma, but this becomes an option only after trials of various medications have proven ineffective, or inadequate.

What can I do for myself and my baby when I have glaucoma during pregnancy?

It is very important to follow the instructions of your physician, taking your glaucoma medications and keeping up with eye examinations.

Resources for glaucoma in pregnancy:

For more information about glaucoma during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446] or check the following links:

 

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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