1. I have glaucoma. I am pregnant. What do I do?

Ideally, you should have discussed with your ophthalmologist that you were planning to have a baby. The doctor could have suggested alternate methods for lowering your eye pressures, since most eye drops can have a deleterious effect on your baby. The most common alternative is Selective Laser Trabeculoplasty, SLT.

Now, your doctor will carefully consider the potential dangers to the baby with the risk of worsening glaucoma in your eyes. These precautions hold true for your pregnancy, as well as during the time that you are breastfeeding, since the glaucoma medicines are found in both your bloodstream and breast milk.

In case eye drops are essential, you can minimize the absorption of the medication into your bloodstream, and that of the baby, by gently pressing on the inside corner of the eye (nasolacrimal occlusion).

See technique for putting eye drops.

2. How will glaucoma medications affect my baby?

Any glaucoma medication may affect the baby, especially during the first three months of pregnancy. Please understand that all of the information we possess is from laboratory studies, conducted on animals, and may not be exactly true for human beings. That said, it is extremely important to stay vigilant about your glaucoma drops during both pregnancy, and lactation.

Carbonic anhydrase inhibitors should be used with caution in the first trimester because of reports of deformity of the embryo. Beta blockers get concentrated in breast milk, and should be avoided if possible by nursing mothers. Pilocarpine has shown no effects when used in early pregnancy, but can cause fits in the newborn. Prostaglandins may induce premature labour

3. I have glaucoma. Can I go ahead with LASIK for spectacle removal?

Glaucoma is a not an absolute contraindication for LASIK. However, LASIK permanently alters the shape and properties of your cornea, making subsequent eye pressure recordings unreliable.

Also, the high pressure exerted on the eye during LASIK may injure the already compromised optic nerve. Steroid eye drops that are used post operatively may also result in pressure spikes in predisposed eyes.

Most doctors, therefore, prefer to rule out glaucoma before LASIK is planned, and deter patients with diagnosed from the procedure. A safer procedure would be femtosecond laser or photorefrative keratotomy, PRK, in case the patient’s visual needs are significant.

4. I have had LASIK. Now my doctor says I have glaucoma. How is it possible?

Diagnosing and monitoring glaucoma in patients after LASIK is challenging for your eye doctor. Very often, since the cornea is thin after LASIK, the available devices underestimate eye pressures. The doctors rely heavily on optic nerve examination and visual fields to diagnose glaucoma.

In susceptible eyes, the brief but significant rise in eye pressures during LASIK can cause optic nerve damage. The use of steroids in the postoperative period can cause a steroid induced glaucoma. It is also possible that a diagnosis of glaucoma was missed before surgery, or you developed the disease recently.

5. I have glaucoma. Can I drive?

Most glaucoma patients can go about their life without any functional impairment. However, in severe disease your doctor may ask you to restrict your driving, or stop it all together because of advanced field loss.

6. I have glaucoma. Can I exercise?

Yes. Exercise is known to help maintain your general fitness and also is known to be an important stress buster. Yoga is known to help manage both physical fitness and stress as well. There is some evidence that the headstand or the shirshaasan may result in brief but significant rise in eye pressures, and so must be avoided in glaucoma patients.

7. I have glaucoma? I also have cataract!

Both cataract and glaucoma are more common in the older age group, they often co-exist. Sometimes treatment for one can contribute to the development of the other.

Glaucoma typically has no symptoms, but the loss of vision due to it is irreversible. On the other hand, cataract results in clouding of vision which can be reversed by surgery.

Your doctor will therefore evaluate the severity of each before deciding on the treatment plan. Typically, most doctors would want your eye pressures to be controlled before cataract surgery. The usual exception to this rule is when your visual needs are such that waiting for eye pressure control is difficult. The second situation is in case of angle closure glaucoma, where your doctor might want to remove the cataract earlier to obviate the need for a laser peripheral iridotomy.

In case you are planning cataract surgery, please remember that multifocal IOLs (intraocular lenses) are to be used with caution in patients with moderate to severe glaucoma.