Medical Model

Serving the Changing Visual Needs of Women Patients

By Gina M. Wesley, OD, MS, FAAO

Providing eyecare that serves the needs of women who are pregnant or experiencing other hormonal changes meets a vital need and projects a family-friendly message.

Women sometimes have eyecare challenges that differ from men due to the hormonal changes that they experience during pregnancy and at other times in their life such as through the use of contraceptive pills and during menopause. I should know–I am currently expecting my second child and experiencing these very symptoms as I struggle with what is usually comfortable contact lens wear. Suddenly I find myself uncomfortable in the same contact lenses I wore with ease before becoming pregnant.

For me, the trick has been high-quality artificial tears and switching to a new silicone hydrogel daily replacement lens. I also am taking my contact lenses out earlier in the evening, which seems to help. This discomfort occurred in my last pregnancy and was then resolved after I had the baby, so I’m hoping the same will happen this time. My associate monitors my eye health to ensure I am not experiencing excessive inflammation or irritation.

Many of your patients will experience similar symptoms due to hormonal changes. Here are some key points to consider about keeping women’s eyes comfortable through hormonal changes including pregnancy.

Eyecare Pre- and Post-Pregnancy:
Most Common Challenges

POTENTIAL PROBLEMS PRE-PREGNANCY

  1. * Tricyclic birth control pills may contribute to variable dry eye symptoms.

POTENTIAL PROBLEMS DURING PREGNANCY

* Dry eye syndrome

* Gestational diabetes

POTENTIAL PROBLEMS AFTER DELIVERY

* Dry eye syndrome during breastfeeding

* Medical, refractive, strabismic and/or developmental problems with the baby.

In Exam Room: Educate and Reassure Patient

In order not to assume anything, I do not address pregnancy eyecare concerns until a woman has told me she is pregnant or asks about it on her own before then. I start by reassuring the patient that pregnancy usually doesn’t cause major issues with eye health, but for those issues I do see, it usually has to do with contact lens intolerance due to hormonal changes in the tears and ocular tissues (most likely) or minor prescription changes that may or may not be permanent. The biggest concern I have is the development of gestational diabetes and potential diabetic retinopathy.

At my practice, we usually just try to do what we can to get pregnant patients through any discomfort as we know there is an end in sight. It’s good to let them know, however, that breastfeeding may extend the issues. Despite the potential for ongoing discomfort, I also let patients know that I am a big fan of breastfeeding as the benefits for the baby’s eye development through breast milk are fantastic!

There are significant brain development advantages to breast milk. It is common for baby formulas to advertise that their brand offers all the necessary nutrients for eye and brain development. Breast milk is even better than those formulas as it naturally contains all of those nutrients. Since 30 percent of our overall brain function is dedicated to vision, the same nutrients in breast milk that enhance brain function also, therefore, are beneficial to the infant’s vision.

Let Them Know You Will Treat As Needed

Generally, seeing pregnant patients for their routine annual exam is sufficient, and then we tailor follow up as needed for each case. For instance, we may have a dry eye patient back or a contact lens patient back if they are really suffering. We usually offer palliative treatment options, such as non-preserved artificial tears, warm compresses for lid health, changing of contact lens solutions and/or brand and modality to see if that helps in a pregnant contact lens patient. If a patient is diagnosed with gestational diabetes, I do typically have them back again for retinal photos to monitor for retinopathy, especially if they are insulin dependent.

Added Precautions Recommended for Pregnant Patients

I don’t dilate pregnant or nursing women unless there is a prominent need to do so to adequately check the health of the eye (for instance, diabetes, risk of retinal detachment, or any other sight-threatening condition). In those cases, I have them use punctal occlusion to limit systemic absorption. Rarely, I do come across situations of red eye/infections.

Notify OBGYN When Necessary

I write a letter to the pregnant patient’s practitioner so they are aware of any eye issues. For a small percentage of women with gestational diabetes, the issue doesn’t resolve after pregnancy, so it’s good to establish eyecare right away. Additionally, if they had gestational diabetes in previous pregnancies, it’s likely to come up again if they get pregnant, so knowing what they need to do for eyecare is important.

Conceptive Pills Also Cause Hormonal Changes

Even before women become pregnant, they may be experiencing eye discomfort related to the kind of birth control pills they are taking. If a woman has a sudden change in experiencing dry eye, or notices a pattern of dryness throughout the month, that is a flag for me to ask questions about what type of birth control she is on (I’ve suggested many times for women that it seems to be better with monocyclic brands than tricyclic because the monocyclic pills provide a steady dose of hormones whereas the tricyclic pills change hormone levels weekly and can be more problematic for SOME women).

Opportunity to Begin Education About Pediatric Eyecare

I’m very active in the InfantSEE program. I tell my pregnant patients about the program as a “gift to them and their baby” as the comprehensive exam is complimentary. As long as the baby is developing normally, they should have an eye exam in the first six to 12 months, again between ages 3-4, and every year thereafter. If there is a problem, there will be more exams scheduled. I have a bulletin board in my office dedicated to me taking pictures with the infants and then posting them up (with parents’ permission). It’s right by the front desk, so it’s a great conversation piece and helps to educate others about the program. ROB Editors note: Make sure you have the HIPAA Marketing Release Form signed before using marketing materials featuring patients.

Provide Focused Women’s Eyecare: Action Plan

Address any needs or concerns pregnant patients have. Just because they are only pregnant for a short time doesn’t mean their issues don’t deserve attention. That means also educating pregnant patients on what to expect in possible changes to eyes including the possible need to switch contact lenses temporarily and dry eye symptoms.

Follow-up appropriately with pregnant patients depending on their particular concerns. For example, if the patient has been moved into a different contact lens, follow-up to make sure the new lens is now keeping their eyes comfortable.

Use patient pregnancy as an opportunity to educate about appropriate eyecare for themselves, as well as their baby. Let them know about the InfantSEE program. If they have older children, the education you provide often reinforces (or initiates) eye exams for them, as well.

Related ROB Articles

Educate Patients on Preventative Eyecare

Improve Medical Eyecare Treatment Compliance by Tailoring Regimens to Lifestyle

Medical Eyecare Opportunity

Gina M. Wesley, OD, MS, FAAO, is the owner of Complete Eye Care of Medina in Medina, Minn. To contact her: drwesley@cecofmedina.com.

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