Oftalmologia Pediátrica e Estrabismo

Pregnancy and eyesight

Should a woman have special eye care during pregnancy?

A pregnant woman should have, first of all, general care compatible with a healthy life. This includes an appropriate diet, a good balance between adequate physical exercise and rest, and abstinence from smoking, alcoholic drinks and drugs. Supplements of vitamins and trace elements are also necessary, such as for example: folic acid, iron and calcium.
Pregnancy should be planned and preceded by general health care. It is fundamental to check the general health condition before getting pregnant or to stabilize a pathology that may get worse with pregnancy.
The alterations of the general metabolism, hormonal profile and blood circulation in a pregnant woman can affect the functioning of the visual system. Besides these physiological changes, some diseases with visual repercussions are frequently aggravated during pregnancy. These pathologies (for example, diabetes and some types of tumours) should be screened and/or compensated before pregnancy.

Is it true that pregnancy alters the value of refractive errors?

The change of corrective lenses is not advised for pregnant women?
The most generalized idea is that myopia increases during pregnancy. In some cases, an increase of the thickness and curvature of the cornea and of the curvature of the crystalline lens can lead to a refractive deviation towards an increase of a preexisting myopia.
But the majority of the existent studies did not demonstrate, until now, that pregnancy is a factor of risk for the increase of refractive errors.
Nevertheless, good sense advises that, whenever possible, the change of corrective lenses should be postponed, to avoid the risk of a new change after a short period of time.
The situation is different in case of contact lenses. During pregnancy, the sensitivity of the cornea diminishes, its thickness increases and it presents oedema due to an accumulation of liquids. There is then a greater risk of intolerance to contact lenses, even in the case of experienced wearers, and so these should never be prescribed or changed during pregnancy.
Refractive surgery with laser is also contraindicated because of the alterations occurring in the cornea.

Should a pregnant woman consult an ophthalmologist?

A young and healthy woman, with a pregnancy without factors of risk, does not need to consult an ophthalmologist.
An ophthalmological examination and regular surveillance are justified in the presence of pathologies involving sight and susceptible of being aggravated during pregnancy, such as, for example, diabetes or some types of tumours, namely tumours of the hypophysis, meningiomas and choroid melanomas. An immediate consultation of an ophthalmologist is also justified by the appearance of other diseases capable of involving the visual system, as it happens in eclampsia, preeclampsia or occlusive vascular diseases.

Which are the risks of pregnancy for eyesight and which are the most frequent problems?

During pregnancy, three types of alterations may occur in the visual system:

1. Alterations (physiological) related to pregnancy:
– less sensitivity and increased thickness of the cornea due to oedema;
– reduced ocular pressure;
– pellicular pigmentary alterations (“chloasma”);
– alterations of the visual field;
– transitory alterations in focusing (accommodation).
These are transitory alterations with no repercussions in vision.

2. Diseases involving sight and related to pregnancy:
– eclampsia and preeclampsia;
– occlusive vascular diseases.
They can have visual repercussions, from slight impressions to severe loss of sight. The recovery may be complete or serious sequelae may persist causing a significant visual deficit. After childbirth, there is always a rapid improvement of the lesions.

3. Preexistent diseases involving sight and susceptible of being aggravated by  pregnancy:
– diabetes;
– tumours: of the hypophysis, meningiomas, melanomas.
Visual problems improve after pregnancy, but sequelae may persist, causing a loss of sight more or less serious.

Can these risks be prevented?

Care and prevention should precede pregnancy. All women should be submitted to a complete checkup before getting pregnant, in order to ascertain that their health is normal and that they have no diseases or alterations susceptible of complications during pregnancy. If, in spite of the existence of this type of alterations, the woman decides to get pregnant, these alterations should be controlled before and during pregnancy.
This control is particularly important in diabetic pregnant women. The control of glycaemia is the most important factor in the prognosis of the visual and systemic alterations of the pregnant woman and of the foetus. Diabetic women should have children as early as possible: the length of the evolution of diabetes is the major factor of risk for the presence, severity and progression of diabetic retinopathy.
All diabetic women should have an initial ophthalmological examination during the first trimester of pregnancy; the follow-up depends on the evolution of the systemic and ocular disease. In case of inexistence of diabetic retinopathy, at least a new examination should be made during the third trimester, to monitor any alteration.
In patients with serious alterations due to retinopathy, namely with neovascularization of the retina, the delivery should be made by caesarean section, to avoid the risk of haemorrhage during the effort of a normal childbirth.

Which advices should be given to pregnant women, to prevent the development of visual problems during gestation?

The advices are: a healthy diet, which should include supplements of vitamins and trace elements, moderate physical exercise, metabolic control, weight control, screening and medical surveillance of alterations or systemic diseases capable of aggravating and/or causing ocular alterations during pregnancy.

Women with vision problems before pregnancy should have a special medical surveillance? How frequently?

In these cases, surveillance care should be always individualized, according to the pathology, its severity and its evolution.
Different pathologies can have different critical moments for medical surveillance. Some may be aggravated by pregnancy, such as, for example, diabetic retinopathy, Graves’ disease or some types of tumours. But others, such as glaucoma or inflammatory diseases (uveitis) of the eyeball may get better during pregnancy and get worse after delivery: in these cases, surveillance should be more rigorous after childbirth.
Frequently, pregnant women with strong myopia fear the occurrence of ocular complications during normal delivery, but there is no reason for apprehension, as there is no additional risk for eyesight.

After pregnancy, which health care should women have?

Eye care is necessary, especially if any visual complication occurred during pregnancy. The majority of visual alterations revert after delivery but, in more severe situations, sequelae may persist and they should be identified and treated.
Another type of required health care concerns diseases that sometimes improve during pregnancy but may worsen after delivery, such as glaucoma and some types of uveitis. For example, for pregnant women with ankylosing spondylitis, medical surveillance is very important during the first months after delivery, because in that period about 20% of them develop an episode of uveitis.

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