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    Using medications in pregnant glaucoma patients

    Safety a concern when prescribing medications for pregnant patients

    Most of the medications, both new and old, we prescribe for glaucoma are quite safe—especially if we educate our patients to occlude their puncta.

    When thinking of the potential for adverse effects, non-selective beta blockers come to mind first for many clinicians because of their well-known propensity to exacerbate the signs and symptoms of pulmonary diseases—such as bronchial asthma and chronic obstructive pulmonary disease.

    Prostaglandin analogs also come to mind, with their effects on eyelash length and iris color. The effect of eyelash lengthening led to Allergan’s formulation of bimatoprost (Lumigan) into Latisse that has gained FDA approval.

    Previously from Dr. Casella: How oral and dental hygiene plays a role in glaucoma

    All in all, the glaucoma medications we commonly prescribe are typically safe, even for our older patients.

    With that being said, I recently had a glaucoma patient of mine become pregnant.

    She is a 42-year-old African-American female with a known history of bilateral primary open-angle glaucoma for three years.

    Patient history

    She first presented as a new patient for an eye examination and new glasses with intraocular pressures (IOPs) in the low 30s in each eye. Her glaucoma was determined to be in its earliest stages—with mild structural changes and no glaucomatous defects on visual field studies.

    Her angles showed moderate pigment, and her central corneal thickness values were average in each eye. After a brief discussion weighing her young age with her risk of progression, she agreed to treatment and selected medical therapy over a consult for selective laser trabeculoplasty.

    Since then, she has had an excellent response to treatment with a prostaglandin analog in each eye at bedtime. Her IOPs consistently were in the high teens (yielding about a 40 percent drop from her maximum measured IOPs), and she has not shown structural or functional progression, either.

    Related: How alcohol consumption correlates with glaucoma

    Pregnant with glaucoma

    She returned for a comprehensive examination and fundus photography this past fall with exciting news. She and her husband were expecting their first child.

    She was about eight weeks pregnant with no problems. She asked me if her drops would be safe during pregnancy and while nursing.

    Benjamin P. Casella, OD, FAAO
    Dr. Casella, a 2007 graduate of University of Alabama at Birmingham School of Optometry, practices in Augusta, GA, with his father in ...


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    • [email protected]
      Why not switch her initially to CAI? Always have to consider issue with compliance and not showing back up in timely manner. Seems like it would make more sense to change to CAI in case compliance is an issue as long as target IOP is accomplished. Hunter Bond, OD
    • [email protected]
      I'm curious why you would treat with Alpha agonist with intent of changing to CAI in a few months? Why not change initially to CAI? Only reason I comment is risk of compliance and possibly not coming back for follow up in a timely manner. Hunter Bond, OD

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