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Pregnancy and Vision

 

One of our optometrists, Lily is expecting her first child in October.  She has written some information on eyesight and eye changes that can occur during pregnancy.

 

Expecting? Then you might also expect some changes to your eyes during the course of pregnancy and those pregnancy hormones are to blame. Hormones have so much to answer for!

The hormones may cause fluid build up in the cornea or crystalline lens inside your eyes (just like the ankles and the feet!), leading to an increase in thickness and curvature. Hence, many women notice their vision to be not as sharp as usual during pregnancy and becoming more myopic (short-sighted). (1) That’s why it may not be an appropriate time to be fitted with new glasses or have refractive laser surgery done. The good news is that most of these changes will return back to near pre-pregnancy levels after giving birth or breastfeeding. (1)

Ironically, while your emotional tears don’t seem to be lacking, the pregnancy hormones actually reduce normal tear production! This may also continue on while you are breastfeeding. The increase in oestrogen and reduced androgens may cause Meibomian Gland Dysfunction (MGD) leading to unstable tearfilm and faster tear evaporation. (2) The dry eye symptoms and physical changes in corneal curvature can also cause reduced tolerance to contact lens wear.

On a more serious note, visual disturbances may also signal severe systemic health issues like high blood pressure, preeclampsia or eclampsia which occurs after 20 weeks of gestation (3,4). According to the Royal Women’s Hospital in Victoria, mild pre-eclampsia occurs in 5-10% of pregnancies and severe pre-eclampsis in 1-2% of pregnancies in Australia(5). Some of the symptoms to watch out are: double vision, blurry vision, temporary vision loss, seeing spots or flashing lights, loss of side vision, swelling around the eyes (4).

Pregnancy may have temporary beneficial effects on pre-existing glaucoma as intraocular pressures decrease (7,8). However, certain glaucoma medications may be contraindicated during this time so remember to check with your optometrist or ophthalmologist.

Violent, forceful vomiting during morning sickness has been reported to cause retinal or conjunctival blood vessels to burst (6). This is consistent with Valsalva retinopathy where a sudden increase in intraocular venous pressure causes retinal capillary to rupture and can be a result of violent coughing, vomiting or straining(6), or a similar event in the conjuntiva, which results in sub conjunctival haemorrhage.

Women with pre-existing diabetes or gestational diabetes may develop diabetic retinopathy where the retinal blood vessels are damaged leading to retinal haemorrhages or swelling. If you already have diabetic retinopathy present prior to pregnancy, there is an increased risk of progression during pregnancy(9).

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1. Pizzarello, L.D. Refractive change in pregnancy. Graefe's Arch Clin Exp Ophthalmol (2003) Jun; 241(6) 484-8

2. Sullivan DA., Sullivan BD., Evans JE., Schirra F., Yamagami H., Liu M.,Richards SM., Suzuki T., Schaumber DA., Sullivan RM., Dana MR.. Androgen Deficiency, Meibomian Gland Dysfunction, and Evaporative Dry Eye. Annals of the NY Academy of Sci (2002), 966: 211–222

3. Hanan H., Rajae D, Hypertensive Retinopathy Associated with Preeclampsia. N Engl J Med (2014); Feb; 370:752
4. Roos N.M., Wiegman M.J., Jansonius N.M., Zeeman G.G. Visual disturbances in (pre)eclampsia. Obstet Gynecol Surv. (2012) Apr;67(4):242-50.

5. https://www.thewomens.org.au/research/research-centres/womens-pregnancy-research-centre/prc-themes/pre-eclampsia/

6. Netan C., Rajesh C.R. Valsalva Retinopathy N Engl J Med (2014); Feb 370

7. Dinn RB., Harris A., Marcus PS. Ocular changes in pregnancy Obstet Gynecol Surv. (2003) Feb;58(2):137-44.

8. Gotovac M1, Kastelan S, Lukenda A. Eye and pregnancy (2013) Apr;37 (1)189-93

9. Ruth A.S.,, Moshe H., Smadar FC. , Michal K., Dov W., Bella S, Yuval Y., Diabetic Retinopathy during Pregnancy. Ophthalmology (1996) Nov:103 (11) 1815-1819

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