Chat Highlights
Glaucoma and Pregnancy
February 14, 2001

Norma Devine, Editor

On Wednesday, February 14, 2001, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Glaucoma and Pregnancy." 

Moderator:  Dr. Rick, tonight our topic is "Glaucoma and Pregnancy."  Are there any concerns for a woman who is pregnant and has glaucoma?

Dr. Wilson:  Yes, there are concerns.  Because the number of glaucoma patients who are pregnant is small, the drug companies have expended very little money testing the side effects of  glaucoma medications on the baby or fetus.  Therefore, we use drops only when the sight is threatened, and then only medications like Propine, Betoptic, Iopidine and, lastly, Timoptic.  We always use tear duct obstruction, as well.

P:   Are those drugs less likely to cross the placenta, or what advantages do they present compared to other eye drops?

Dr. Wilson:  They are mild, with the fewest systemic side effects.  Iopidine has had more testing in pregnancy than the others and seems well tolerated.

Moderator:  Are fertility drugs a concern?  

Dr. Wilson:  Not for the glaucoma, to my knowledge.

Moderator:  Are there any types of glaucoma that are more easily passed down? 

Dr. Wilson:  Yes,  there are dominantly inherited glaucomas like Rieger's syndrome.

P:  I'm trying to get pregnant.  I am 32 and I was born with a persistent hyperplastic vitreous (PHPV) in my left eye. The other eye is healthy and has good vision.   The PHPV was removed when I was seven years old due to lower pressure, but the pressure has wavered around 30 to 40 for past seven years due to glaucoma.  I have little vision in the eye (light/shadows), but would like to prevent pain and further deterioration (iris is getting lighter). Which is the most/least harmful drop or should I stop altogether? I have been using Timoptic and Voltaren (for inflammation).  

Dr. Wilson:  It is a difficult issue because the eye is so poor. If you see very little out of it, I would be leery of using glaucoma drops during the first half of your pregnancy. If you do, Timoptic 1/4% XE daily, with occlusion of your tear duct, would be a sensible way to go.

P:   Will childbirth increase intraocular pressure? 

Dr. Wilson:  Actually, pregnancy increases the outflow from the eye, so even though the mother-to-be is retaining water and feels like a walrus, the IOP pressure is usually down.  Childbirth will surely raise eye pressure, blood pressure, and probably any other kind of pressure you have.  The drugs used are probably O.K. , though it has been years since I've been in a delivery room.  The main thing is not to have too much of a drop in blood pressure due to the drugs.

P:  Does low blood pressure affect glaucoma?  I have low blood pressure. 

Dr. Wilson:  Low blood pressure lessens the force of  blood that is driven into the eye to service the nerve and retina.  It is a risk factor for glaucoma.

P:   How low is low?

Dr. Wilson:  By low I mean 90/58.  Any idea what your blood pressure might be at night?  

P:  No.  Actually, I am on Maxide, and when I exercise my blood pressure rises to 110 over 60.  It fluctuates a lot.  

Dr. Wilson:   Fluctuation is very common.  

P:  Doctor, after  reading information you provided here, I increased my salt intake (I had borderline low sodium), and raised my blood pressure from 90/60 to 120/70.  

P:  Does pregnancy raise IOP in normal or glaucomatous eyes?

Dr. Wilson:  No, pregnancy lowers IOP in most patients and non-patients. 

P:  Why is that?

Dr. Wilson:  Pregnancy increases the outflow from the eye.  I don't think anyone is sure why that  happens.  

P:  Would it be okay to use glaucoma eye drops during pregnancy once a week instead of every day?

Dr. Wilson:  The fewer you use, the less chance of harm to the baby, but that would leave you unprotected from the IOP for much of that time.  I, personally, would take as little steroids as possible to keep the eye calm, and forget the glaucoma medications for the first half of your pregnancy.

P:  I would guess pressure would have to be low continually to cause damage?  Is that right?  

Dr. Wilson:  No.  Even if the IOP were only low from 2:00  to 4:00 a.m. it could do you harm.

P:   On the other side of the question, doctor, are there any problems if the male is on meds?

Dr. Wilson:  Only if  he is using systemic steroids or if the meds lower his systemic blood pressure.

P:  Any idea how long these drugs remain in your system?

Dr. Wilson:   Probably less than 24 hours in the blood stream. Some may have a lingering effect on IOP for two to three weeks.

Dr. Wilson:  Would the group like to have a retina specialist or another type of eye specialist as a guest?

P:  I would.  I have had laser in both eyes for torn retina.

Moderator:  Yes, a retina doc would be nice.

Dr. Wilson:  Okay.  I will enlist a retina doctor to appear as a guest.  Have a great week.

On February 21, Dr. Wilson discussed "What is Glaucoma?" in the Chat room. Click here for highlights of that meeting.

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