Summary

Glaucoma is often called the "silent thief of sight" because it frequently remains undetected until significant and irreversible vision loss has occurred. While traditional tools like eye pressure checks and visual field tests remain the bedrock of care, researchers are developing Artificial Intelligence (AI) and Machine Learning (ML) tools to make these assessments more objective, personalized, and accessible.

Glaucoma and Pregnancy

 

It’s important for women with glaucoma to work closely with their ophthalmologist and OB/GYN when thinking about having a family. By discussing plans to become pregnant, a concerted effort can be made to achieve intraocular pressure (IOP) control on minimal or no medications, minimizing risk to the fetus while safeguarding the eye.

The goal is to minimize drug exposure to the fetus throughout the pregnancy, but especially during the first trimester, when the risk is greatest. The treating ophthalmologist must weigh the potential risk to the mother’s vision against the risk to the fetus. Some patients are able to discontinue all glaucoma medications for the first 12 weeks. This might be possible, for example, if a patient is a glaucoma suspect or has early glaucoma with limited optic nerve damage and modestly elevated IOP. Frequent monitoring is the key.

In other cases, going off glaucoma medications is not possible, for example, if a patient has substantial optic nerve damage or extremely elevated IOP levels and is not able to tolerate uncontrolled IOP even for a short period of time. In such cases, the physician would try to prescribe the fewest possible medications, thoughtfully selected and dosed to minimize risks to the fetus. 

Sometimes surgery, such as laser trabeculoplasty, may be the best option for patients who cannot achieve an acceptable IOP level with minimal or no glaucoma medications. If possible, surgical procedures to control IOP are best performed prior to conceiving so that the IOP level can be controlled and stable throughout the entire pregnancy. If necessary, laser trabeculoplasty can be performed during pregnancy. Incisional surgery, such as trabeculectomy, is safest prior to conception. If surgery is required during pregnancy, trabeculectomy is probably safest in the second trimester. In such surgical cases, topical or local anesthetic is preferred.

There is no data suggesting problems with labor and delivery of a newborn. Periods of extreme straining during delivery may raise IOP, but this is very brief. Nursing must be considered as well, and warrants a discussion between the patient and her doctors as glaucoma medications may also be secreted into breast milk when nursing. Decisions on glaucoma treatments during the nursing period must be carefully considered.

And finally, many mothers ask if their glaucoma puts their child at risk for developing the disease. Family history is a significant risk factor. Once a child is old enough to sit still for an eye examination, the child should get tested, and retested at periodic intervals.  Be sure to let your child’s pediatrician know that you have glaucoma.