Some of you may have noticed I haven’t been posting as much as I normally do.  Those of you who have seen me in person lately know that’s because I’m pregnant!  Actually, now, 37 weeks pregnant and the older I get, each pregnancy gets a little harder.  Though I have gained the least amount of weight of all my pregnancies, I’m still tired and that has left little room for blogging, after work, taking care of two kids and managing our practice.  However, it did remind me that most women are unaware of how pregnancy can actually affect their eyes, so I thought the topic did deserve a post.

Pregnancy is obviously characterized by 40 weeks of hormones from your placenta which now affect the rest of your body.  These hormones can cause physiologic and pathologic changes in Mom and baby.  Also, as a pregnant woman, certain medications are contraindicated if you do develop an eye condition and I wanted to review some of the more common ones.

Common Eye Conditions:

1.  Viral conjunctivitis, or pink eye.  This is characterized by tearing, redness and discharge.  It often spreads from one eye to the other.  You should wash your hands frequently and it is highly contagious the first 5 days of infection. Supportive measures such as cold compresses and artificial tears are the best.  Antibiotic drops are useless against viruses, so no need to take them.

2.  Allergic conjunctivitis – this one drives me crazy, especially in Hawaii during mango season.  You’ll get the same red, watery eyes, but also accompanied by itching and sneezing.  Unfortunately, it’s not recommended to use allergy drops such as Patanol, Pataday or Lastacaft during pregnancy.  So, supportive measures such as cold compresses and artificial tears are the best option during pregnancy.

3.  Dry eyes -Many women experience dry eyes pregnancy due to the hormonal changes.  Symptoms include light sensitivity, feeling like there’s sand in the eyes and even tearing.

Tips

  • Take frequent breaks when reading
  • Use preservative free artificial tears (sensing the theme here? artificial tears are GOOD during pregnancy!).  And, remember – Visine is NOT an artificial tear!

4.  Change in glasses and contact lenses prescription.

You may notice that you don’t seem to be seeing as well with your current glasses or contact lens prescription when pregnant.  Everything becomes fluid filled when you’re pregnant, even your eye structures.  This fluid changes your glasses and contact lens prescription.  Women complain “I can’t see at night”.  Pregnancy can also cause more nearsightedness (myopia) and astigmatism which is temporary.  I always advise pregnant patients not to change their prescriptions when pregnant, because it may not be accurate.  Wait at least few weeks post-partum before getting a new prescription.  If you are nursing, I would wait around 6 months (until you are no longer exclusively breast feeding) to get your new prescription for the highest accuracy.

5.  NO LASIK!!

This goes hand in hand with the recommendation that laser vision correction is NOT recommended during pregnancy or immediately post-partum.  If your prescription is changing, then your doctor cannot be sure of the calculations necessary to give you a good surgical outcome.  Also, the mild sedatives which are given before LASIK and the steroid drops given post-operatively are not allowed during pregnancy.

 

 

 

 

There are also abnormal eye problems that can occur during pregnancy that you should ‘watch’ out for (i know that was a weak one!).

  • High blood pressure
  • Retinal problems
  • Blood vessel clots
  • Worsening of diabetes
  • Worsening of tumors

1.  Eclampsia – This is very severe high blood pressure after the 20th week of gestation.

It usually occurs with your first child and causes swelling in your legs and problems with kidneys.  It can cause seizures, headaches, stomach pain andvominting as well as vision abnormalities.  This is why your OB will always ask you about headaches or blurry vision.  You might see lightning flashes, blacking out of part of your vision, double vision or it just might be blurry.  Let your OB know right away if you experience any of the above symptoms.  Typically the eyes improve when the medical condition is treated and usually the baby must be delivered to stop eclampsia.

2.  Glaucoma

Some patients have glaucoma and then later become pregnant.  Most of the glaucoma drops are contraindicated in pregnancy because they can induce preterm labor and decrease the baby’s heart rate.  If you have to use drops, then practice punctal occlusion.  That’s when you place the drops in the eye and then hold pressure at the inner corner to minimize the systemic absorption of the drop. 

 

 

 

 

 

 

 

3.  Gestational diabetes

This is the one I’m blessed with.  I didn’t have it for my first two boys, but now that I’m over 35 years old, my risk increased and I was diagnosed with diabetes.  It has nothing to do with weight gain during pregnancy (I’ve only gained 14 pounds during the entire 37 weeks of pregnancy) or fitness level.  Most people are really surprised to learn that I have gestational diabetes.  Gestational diabetes is when your blood sugar levels become elevated during pregnancy in women who have never had diabetes before. Gestational diabetes starts when the mother’s body is not able to make and use all the insulin it needs during pregnancy. If you have gestational diabetes, you should see your ophthalmologist every trimester to assess for bleeding in the retina.  However, your risk for developing retinopathy is much lower if you were diagnosed with gestational diabetes than if you had a diagnosis of diabetes prior to getting pregnant.  If you had diabetes (Type I or Type 2) before becoming pregnant, than your risk of bleeding in your eyes is higher during pregnancy.   However, the good news is that most long term studies have shown that progression of retinopathy reverses after delivery and that there are no long term changes.

4.  Blood clots in your eyes

As you advance in pregnancy, the blood becomes more viscous and thick.  Clots can form in your legs, lungs and even eyes.  Sudden, profound, painless vision loss must be reported immediately to your OB and ophthalmologist because this could be a “mini-stroke” in your eye or artery occlusion.

5. Central serous chorioretinopathy

This is relatively rare, but I just saw a patient who was in her first trimester who had central serous chorioretinopathy.  Basically, this is a blister of fluid which builds up in the center most part of your retina, called the macula.  Usually these occur in Type A personality (you know, OCD, stressed out, perfectionistic type ) males in their 30’s and 40’s.  It’s induced by stress, hormones, and steroids.  However, those same hormones in pregnancy can cause CSCR in pregnancy.  Patients experience blurry vision, sudden onset of dim vision, waviness in your vision, decreased color vision, and the feeling that things look smaller in one eye than another.  Definitely see your opthhalmologist for any changes in your vision during pregnancy.

 

 

 

 

 

 

 

 

 

 

Please forgive any typos – I am posting this from the hospital bed where I am in labor!  Finishing this post is helping distract me from the pain of contractions!!

 

Children and infants may not be as interested in the fashion statement of sunglasses.  But, babies and kids spend as much as time outdoors in direct sunlight as adults, especially here in Hawaii.. In addition, the crystalline lens inside the eye of people younger than 30 years old is more susceptible to damage from UVB light than that in older adults.  Not only does this susceptibility potentially cause earlier cataracts, but because their lens lets in more damaging UVB light, the retinas of children are more prone to UV toxicity.

So, UV protection for their eyes is even more important for them than for adults.  In the same way that you cover your children in sunscreen and protective hats and clothing when they go outside, so too should their eyes be protected.  Ultraviolet radiation is a great concern in sunny places like Hawaii.  UV light is a part of the light spectrum from the sun to the earth.  Remember this picture from high school?

uv light jpg
In fact, most experts believe that children get 80% of their lifetime UV exposure by the time they are 18 years old!  UV exposure has been linked to the development of cataracts, macular degeneration and other ocular diseases. The risk of retinal damage from sunlight is greatest in children less than 10 years old, although the eye diseases do not develop until adulthood.  UV exposure is the greatest when children are out between the hours of 10 am and 2 pm and if they’re near large sandy beaches and reflective bodies of water.

All sunglasses are not the same.  Effective sunglasses should protect against UVA and UVB light. What’s the difference, you may ask?  Experts used to think that only UVB was harmful, but now additional research has confirmed that UVA light also penetrates the atmosphere causing skin cancer, premature aging and eye damage.  In fact, UVA penetrates the skin and eyes more deeply than UVB light.

However, many expensive sunglasses do not filter out UVA light.  So, it is extremely important to double check that the sunglasses your purchase protect against both UVA and UVB light.

LENSES:

Look for a label or a sticker that says one or more of the following:

  • Lenses block 99% or 100% of UVB and UVA rays
  • Lenses meet ANSI Z80.3 blocking requirements. (This refers to standards set by the American National Standards Institute.)
  • UV 400 protection. (These block light rays with wavelengths up to 400 nanometers, which means that your eyes are shielded from even the tiniest UV rays.)

It should either be marked on the sunglasses or the optician will be able to inform you.

FIT:

Sunglasses should properly fit your child’s face.  If the glasses are too big around the temples or don’t fit their nose bridge well, then they will be continuously falling down.  For infants, I really like the Julbo line.  They are soft and flexible, so they fit babies’ flat noses well, without indenting their nose.   Also, wrap around styles provide the best coverage and protection.  Here’s my son in his Julbo sunglasses when he was around 7-8 months old.

 

Once we started taking him to the beach with us, I put him in sunglasses.   It’s never too early to start having your child wear sunglasses.  Also, of course, he is wearing a large hat, full length UV rash guard and sunscreen.  I always joke with my dermatologist friend that you can spot the doctors’ kids at the beach a mile away.  They’re always totally covered up, whereas other kids are just wearing diapers or little bikinis.

 

POLARIZATION?  WHAT IS THE DEAL?

Another question I get a lot is about polarized sunglasses.  Polarization reduces glare, by filtering out sunlight that bounces on reflective surfaces so it is helpful for people who spend a great deal of time on the water.  However, it is important to note that polarization has nothing to do with UVA/UVB protection.  Just because a pair of lenses in sunglasses is polarized does not mean that it also has UV protection.

 

Above, my younger son is wearing Babiators sunglasses which we have available in our Optical Shop with polarization.  Department stores like Nordstrom also carry them, but without polarization. My older son is wearing no-name sunglasses that I picked up at the store (but they do have UVA/UVB protection) and I’m wearing the new summer Ray-Ban Erika sunglasses, which we also have in our Optical shop.   I love these, they are so light and I feel like they look like candy.  My husband says I have sunglasses addiction, and I might have a collection to rival Brad Pitt’s.  But, hey, we live in Hawaii and I just reviewed all the reasons why sunglasses are medically necessary, so it’s shopping for a MEDICAL reason (that’s my justification for my 8 pairs!)

But, getting back to the kids.  Kids really only care that the glasses are comfortable, otherwise it’s near impossible to get them to keep them on their face. At Honolulu Eye Clinic, our opticians are skilled at knowing the type and fit of glasses best suited to protect your child’s eyes from harmful sunlight.  Our optical shop carries sunglasses for infants to adults, all of which block UVA and UVB light.  I would avoid buying sunglasses for kids online unless you can try them on your children first to insure a proper fit and that your child will tolerate wearing the sunglasses.

 

© 2011 Honolulu Eye Doctor & Mom Suffusion theme by Sayontan Sinha