Glaucoma in pregnancy

Purpose of reviewGlaucoma management during pregnancy generates numerous therapeutic challenges and potential risks for both the patient and the fetus. Data are limited on this topic given the lack of large, prospective, and randomized clinical trials because of ethical and legal constraints in this patient population. Therefore, many ophthalmologists remain unsure about treating glaucoma during pregnancy and lactation. This review focuses on the importance of preconception planning, the natural course of intraocular pressure during pregnancy, and a discussion of various therapeutic modalities during pregnancy and lactation.Recent FindingsThe risks of glaucoma medications during pregnancy are not well established for the human fetus or infant and are often inferred from animal studies. Some guidelines have been provided by the US Food and Drug Administration (FDA) about medication safety during pregnancy. Currently, brimonidine is classified as a category B medication with presumed safety based on animal studies. Other glaucoma medications (beta blockers, carbonic anhydrase inhibitors, parasympathomimetics, and prostaglandin analogues) are classified as category C medications with uncertain safety from the lack of human studies and reported adverse effects in animal studies.SummaryThe treatment of glaucoma during pregnancy and lactation requires careful consideration and understanding of disease status, stage of pregnancy, FDA classification and guidelines, and potential benefits and limitations of various therapeutic modalities. A multidisciplinary team approach is necessary to appropriately balance the risks and benefits of any intervention and to individualize treatment to achieve the best outcomes for both mother and fetus.