Glaucoma and Pregnancy
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DIAGNOSIS AND MONITORING OF GLAUCOMA (J KAMMER, SECTION EDITOR)
Glaucoma and Pregnancy Terri-Diann Pickering 1 & Sunita Radhakrishnan 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This article is a review of studies relating to glaucoma in pregnancy. It also examines medical, laser, and surgical options specific to the particular needs of this population. Recent Findings In general, there is limited data on management of glaucoma in pregnancy, and no guidelines for treatment have been established. In one recent case series, pregnant women exposed to glaucoma medications were found to have no difference in pregnancy or fetal/neonatal outcomes compared with a control group. There are no available data for the use of the newer intraocular pressure (IOP) lowering agents (latanoprostene bunod, netarsudil) in pregnant women. Recent case reports describe various surgical interventions to treat glaucoma in pregnancy. Summary Pregnant women with glaucoma must be monitored closely, and their treatment should include collaboration with their obstetrician. No predictions can be made regarding the course of their IOP or glaucoma. Management has to be determined on a case by case basis. Keywords Glaucoma . Pregnancy . Intraocular pressure . Fetal . Teratogenic . Birth defects
Introduction Traditionally, pregnancy has not been an issue for glaucoma patients since most are well past childbearing age. However, this is changing. Thanks to advances in reproductive technology, women are conceiving at increasingly older ages. Also, we are detecting glaucoma at younger ages, thanks to new diagnostic tools and increasing clinical awareness. Glaucoma in pregnant women may be newly diagnosed or may have been acquired in childhood or young adulthood due to primary or secondary causes. The prevalence of glaucoma during pregnancy has not been specifically reported. However, epidemiological studies in various parts of the world have reported glaucoma prevalence ranging from 0.16
This article is part of the Topical Collection on Diagnosis and Monitoring of Glaucoma * Terri-Diann Pickering [email protected] Sunita Radhakrishnan [email protected] 1
Glaucoma Center of San Francisco, 55 Stevenson St., San Francisco, CA 94105, USA
to 0.48% in women aged 15–39 years and from 0.17 to 3.1% in women aged 40–49 years [1–4]. Glaucoma management during pregnancy is challenging since there are no established guidelines and the available treatment data is limited to animal studies, case reports, or anecdotal information. Treatment of pregnant women is further complicated by the fact that their perception of teratogenic risk is very high. Even when women are exposed to safe medicines, they believe that they are at a 24% risk for birth defects. Women are so reluctant to take drugs while pregnant that there is an increase in non-adherence, with some patients stopping all medications. The reality is that most known teratogenic drugs increase the risk of major birth defects by only 1–3% [5, 6]. All
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