Preeclampsia's deleterious effects on maternal eye health could resurface years following a complicated pregnancy, according to research that suggests doctors monitor for long-term risk of retinal disease.
Published in January's Obstetrics & Gynecology, a new study from the University of Montreal Hospital Research Center draws a correlation between preeclampsia and higher incidence of hospitalization for retinal detachment, retinopathy and other retinal disorders in the decades after pregnancy, compared to mothers who don't experience complications.
Preeclampsia, a serious condition characterized by high blood pressure, is relatively rare, affecting between 5 and 8% of all pregnancies. During pregnancy, preeclampsia is known to cause retinal vascular changes and visual symptoms, including blurred vision, photopsia, diplopia or even blindness; however, less is published about its effects years later.
This is where Canadian researchers hope to fill in the gaps. Tracking more than a million Canadian women between 1989 and 2013—of which about 6% were diagnosed with preeclampsia—researchers found that women with preeclampsia had 1.6 times the risk of retinal detachment and nearly double the risk of other retinal diseases, including retinal breaks and diabetic retinopathy.
Additionally, women diagnosed with severe or early-onset preeclampsia were at greater risk than those diagnosed later, and risk for retinal disease increased steadily in the years post-delivery.
Caroline Beesley Pate, O.D., associate professor at University of Alabama at Birmingham School of Optometry, says the study authors suggest that preeclampsia is an independent risk factor for retinopathy, after adjusting for hypertension and diabetes, which is particularly pertinent for doctors of optometry to note.
"We typically educate our hypertensive and diabetic patients on the importance of yearly eye exams to screen for potential complications, but preeclampsia has not been on the radar as an indication for routine, yearly eye examinations following pregnancy," Dr. Pate notes.
As a result, "doctors of optometry may want to consider, given the strong associations this study is able to demonstrate between preeclampsia and retinal disease later in life, including preeclampsia as an important question to ask our patients during the patient history. We should be aware of the increased risks associated with preeclampsia and educate and follow these patients appropriately."
Pregnancy and routine eye care
Just as every patient is different, every pregnancy is, too. The maternal physiological changes that occur during a pregnancy mean doctors of optometry must take a different approach to the routine care and specialized treatment of these unique patients, Dr. Pate notes.
Here are three considerations that doctors of optometry must keep in mind when treating pregnant patients:
- Diagnostic agents. The risks of topically applied diagnostic agents is very low with no literature linking fetal damage as a result of agents, such as mydriatics, sodium fluorescein dye or ocular anesthetics, Dr. Pate writes. However, "there may be need during a patient's pregnancy to prescribe a therapeutic agent, either topically or orally, and the U.S. Food and Drug Administration (FDA) recently updated its labeling for all new prescription drugs, which eliminates the once-familiar FDA safety categories of 'A, B, C, D and X.'" Dr. Pate continues: "Practitioners now will need to go to the package insert and read the label regarding the possible risks, clinical considerations and data available as it relates to the drug."
- Physiologic and pathologic changes. Hormonal changes associated with a pregnancy can cause numerous physiological and pathological changes. It's common for refractive changes to occur as a result of water retention in the cornea and lens, causing even a mild myopic shift of about 1 diopter or less, Dr. Pate notes. About 80% of pregnant women report dry eye symptoms, likely resulting from hormonal changes, and additionally pregnancy is associated with a higher risk of central serous retinopathy. "Fortunately, most of these physiological changes that occur during pregnancy are transient, however, some can be permanent."
- Pre-existing conditions. "It is a well-known fact that pregnancy can exacerbate pre-existing conditions such as diabetic retinopathy with risk factors including the severity of retinopathy at conception, metabolic control—both before and during the pregnancy—the duration of diabetes, and any coexisting metabolic disease," Dr. Pate writes. For these reasons, it's important for doctors of optometry to closely monitor pregnant patients with diabetes and educate them about the importance of routine comprehensive eye examinations.
"Every pregnancy is unique and different," Dr. Pate notes. "Make sure to identify these patients in your practice—know who they are via a good patient history. Most ocular changes associated with pregnancy are physiologic and reversible."
Read more about how to treat pregnant and breastfeeding patients.
Low Vision Awareness Month is a perfect opportunity to consider implementing such services in your practice and to ensure you have the right connections for necessary referrals to other doctors of optometry who provide this essential care.
Researchers found only about 30% of patients with diabetes abide by four diabetes care practices—including eye exams.