Glaucoma management in pregnancy: A questionnaire survey

Abstract

Background: The management of glaucoma in a pregnant woman can pose a challenge for the ophthalmologist. The risks and benefits to the mother and foetus must be weighed. When it is decided that treatment is necessary, there is no consensus as to the safest treatment. This study was designed to garner the experiences and views of UK ophthalmologists with regard to this scenario. Methods: All consultant ophthalmologists in the UK were sent a questionnaire. They were asked if they had previous experience treating pregnant women with glaucoma, what management they had used, what management they would currently employ, and, if they were to use medical treatment, what would their first choice agent be. Results: A total of 282 out of 605 questionnaires were returned. Of the respondents, 26% had previously treated pregnant women with glaucoma. Most (71%) had continued with the therapy that the women were already on. In all, 34% had observed the situation and had not needed to treat. When asked what they would currently do in this scenario, 31% were unsure. A total of 40% would simply continue the prepregnancy treatment. A total of 45% of respondents, if they were to use medical treatment, would use beta-blockers, compared to 33% who would use prostaglandins. Conclusion: Although it is thought to be a relatively rare clinical situation, over a quarter of our respondents had first hand experience of the management of glaucoma in pregnancy. Our results indicate some uncertainty about the optimal strategy. It is unlikely that trials will be performed and we suggest guidelines be produced using current knowledge and modified as evidence appears.