Thursday, November 28, 2013

Lasik Surgery During Pregnancy

Female patients of mine often ask whether having a child will affect their ability to undergo Lasik eye surgery. Actually, pregnancy can affect the eyes in many ways so it is important to understand what considerations should be made for pregnant women who are considering Lasik. These things should also be considerations even if a woman is not pregnant at the time but may be planning it in the near future.

First, it is always important to establish the total medical and structural health of the eye prior to proceeding with any kind of eye surgery. Pregnant women are known to be at risk for the development or worsening of diabetes and can develop significant blood pressure problems such as preeclampsia. These blood pressure or diabetes related problems can manifest in the eye, and therefore a complete dilated exam of the eye to look for any changes or pathology in the retinal blood vessels is extremely important. Patients can potentially present with bleeding or leaking blood vessels which can cause distortion of vision. Any changes of these kinds need to be handled very carefully to prevent long-term damage to the eyes. These conditions can lead to an acute medical or surgical situation and the patient would definitely be precluded from having Lasik eye surgery. Other rare pregnancy related eye disorders can occur that induce swelling of the optic nerve or retina and can also be detected with a complete eye exam by an ophthalmologist.

But not all eye changes during pregnancy are necessarily pathologic. In some otherwise healthy women, it has been observed that their glasses prescription actually changes during pregnancy. Similar changes can also occur after the baby is delivered while the woman is breast-feeding her child. In some cases, these changes may be temporary but in others they can be permanent. Unfortunately there is no way to distinguish which cases are temporary. Actually, the majority of women never have these prescription changes during pregnancy at all. The exact mechanism of action is unknown although it has been shown that changes in the corneal thickness and curvature occur, possibly due to swelling. Some have postulated that the same hormonal changes which allow for bodily changes to accommodate for growth of the baby within the woman's body also allow for growth of the eye as well. Usually, growth changes of the eye leading to nearsightedness come to a conclusion when a person stops growing in their late teens or early twenties, but perhaps the hormonal changes of pregnancy allow for some of these changes to re-occur later in life.

Of course, when this situation arises, the woman's glasses prescription and nearsightedness are no longer stable and predictable. Performing Lasik on someone like this is unwise because the exact final prescription cannot be known. It's like shooting at a moving target. It is a general rule that a patient should have a stable glasses prescription for about one year prior to having Lasik eye surgery. If my patients go through pregnancy and experience no changes, then I feel it is okay for them to proceed at any point thereafter when they feel ready. However, if changes in their prescription have occurred, I do advise them to wait on Lasik surgery until we have observed that it does not change any further. This waiting period applies to the postpartum breast-feeding time as well.

I also talk to many of my patients that are young women who are not planning on pregnancy in the near future but feel they may have children in the distant future. In these people, there is no way to predict if a future pregnancy will change their glasses prescription. I advise these people most women have little or no change during pregnancy so it is reasonable to proceed with Lasik as they have no immediate plans for having children. They should be aware of the small possibility of developing regression of their near-sightedness in the future in the event they do become pregnant. In those cases, it is possible to do additional treatment after pregnancy is completed and once their prescription is stable. However, if the visual changes are small, many women feel that their vision is adequate and may not need additional treatment or might choose to wear glasses only under certain conditions, eg night driving. Those are personal decisions each individual must make for themselves.

The bottom line is to make sure that any health issues of the patient which can be related to pregnancy are stable and that the overall glasses prescription is stable and predictable prior to proceeding with Lasik eye surgery. Once all of these things are stable and the pregnancy is complete, that is the best time to proceed with the procedure. Although performing Lasik just prior or during pregnancy is technically possible, there remains the small chance of a prescription change induced by the pregnancy which might require additional treatment later. To avoid multiple procedures, I recommend waiting until after the baby is delivered and breast-feeding is completed.

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