Pregnancy and Eye Exams

[Jana Lewis]

I have heard that pregnant women should not have eye exams until after the birth because hormonal changes can effect vision, is this true? Or is this some old wives tale? What about fundus examinations? Can it harm an unborn child?

[Texas Ranger]

Jana, I do know that my children's mother had three c-sections, and she needed +1.50 readers for about a month after each child's birth, otherwise she had no rx at all...

[wmcdonald]

The reason refractions are not indicated is that a change in the RX due to hormonal changes will typically occur. It would make no sense to do a refraction and get new specatcles or contact lenses only to need an additional change in a few months. The refraction nor the fundus evaluation would cause any harm to the fetus or mother.

[drk]

We've all heard this: don't fit CLs during pregnancy, mothers become CL intolerant during pregnancy, large refractive shifts occur during preganacy, etc.
This is all supposedly due to hormonal changes altering corneal curvature, gestational diabetes, etc, etc.

In fifteen years: HAVEN'T SEEN IT! 99% chance that it's safe to proceed as normal, but if something looks odd, well, maybe you should wait.

As far as retinal evaluations harming fetuses: What????????????????????/

[Rophod]

I also haven't seen any significant changes in refraction or corneal curvature with pregnant women. I would do the exam. Due to possible complications like gestational diabetes you should do the exam to provide a higher standard of care since you might be the one to make the diagnosis of diabetes. You might want to warn them, there is a small chance the prescription will change and let them decide if they want to proceed with new glasses or not. I have patients come in and tell us "I have been taking chemo or.....so I didn't want to have my eyes examined". I tell them that is more the reason to get them checked. The eye is a highly diagnostic organ.

[Jana Lewis]

We've all heard this: don't fit CLs during pregnancy, mothers become CL intolerant during pregnancy, large refractive shifts occur during preganacy, etc.
This is all supposedly due to hormonal changes altering corneal curvature, gestational diabetes, etc, etc.

In fifteen years: HAVEN'T SEEN IT! 99% chance that it's safe to proceed as normal, but if something looks odd, well, maybe you should wait.

As far as retinal evaluations harming fetuses: What????????????????????/

The only reason why I asked is because I had a pregnant patinet ask about fundus exams. It appears that the safety of it has not yet been confirmed.

Precautions: Measurement of the depth of the angle of the anterior chamber should be obtained prior to administration of homatropine to patients with a predisposition to glaucoma.

Excessive ophthalmic use, especially in children and the elderly, may produce systemic symptoms of atropine poisoning. Do not exceed recommended dosage. Not for frequent or prolonged use. If dryness of the mouth occurs, decrease dosage. Discontinue use if rapid pulse or dizziness occurs. Homatropine may cause an increase in intraocular pressure. If eye pain occurs, discontinue use immediately as this may indicate undiagnosed glaucoma.

Pregnancy: Safety has not been established.

Lactation: Documentation is lacking or conflicting regarding the excretion of anticholinergics (especially atropine) in breast milk and the reduction in breast milk production caused by these drugs. Although there is no documentation of adverse effects in breast-fed infants, it is advisable to closely monitor infants of nursing mothers for anticholinergic side effects.

[drk]

I'm sorry, I didn't get the part about dilation drops. I do not dilate when pregnant, even though the risk is infinitesimal. I will do undilated reoutine funduscopy and have the patient return post-partum.

[chip anderson]

Don't know about DRK and Rypod's experience but remember, I am old enough to have fit a lot of good ole' PMMA lenses. And yes I did see fitting changes in about 25% of the pregnant women I saw. About half of these were permanent changes and about half went back to normal after 3 months post-partum.

Once upon a time we even blamed birth control pills for most of our troubles (at that time 90% of the women over 14 than I asked, were on the pill and I didn't ask the ones under 14. The only problems I found were rare and confined to the first 3 months on or the first 3 months off the pill.

Chip
:cheers: