Women with keratoconus are at no greater risk for the most common pregnancy disorders than women without this eye disorder. However, hormonal changes that occur during pregnancy can adversely affect the cornea. According to an article in the Journal of Current Ophthalmology in 2018, changes in the thickness and curvature of the cornea often occur in pregnancy. These changes typically resolve after delivery in women without an underlying cornea disorder (such as keratoconus). However, the National Keratoconus Foundation (NKF) reports that worsened progressive vision loss can be a consequence of pregnancy in women with keratoconus.
If you are living with keratoconus, a consultation with a professional at the Precision Keratoconus Center can assist you in learning about your treatment options. The following describe two considerations for women with progressive vision loss due to keratoconus, as well as ways that keratoconus can impact cornea surgery-related decisions during pregnancy.
Changed Contact Lens Needs During Pregnancy
Most keratoconus-afflicted people are prescribed Rigid Gas Permeable (RGP) contact lenses or scleral contact lenses to correct vision. This is because standard contact lenses (commonly-called “soft” lenses) cannot correct astigmatism. Additionally, an experience of “dry eyes” is frequently associated with keratoconus (and this can make wearing contact lenses over an entire workday more difficult).
The American Academy of Ophthalmology notes that temporary changes in refraction often occur during the last trimester of pregnancy (resulting in increased myopia), but the level of myopia typically returns to normal after delivery of the newborn. In contrast – for keratoconus-afflicted pregnant women – progressive vision loss may be exacerbated both during and after the pregnancy.
Notably, an article titled Pregnancy and the Eye in 2015 recommended that contact lenses not be changed during pregnancy (as visual acuity normally returns to baseline following most pregnancies). Yet, keratoconus-afflicted pregnant women may require contact lenses (or eyeglasses) with a “stronger” prescription for vision correction following delivery of the newborn due to the likelihood of progressively-worsened myopia.
Furthermore, an increased experience of “dry eyes” in keratoconus-afflicted women during pregnancy may result in the need to wear eyeglasses (rather than contact lenses) during late-pregnancy and/or in the first month following delivery of the newborn.
Cross-Linking Surgery for Keratoconus and Pregnancy
Cross-linking surgery is typically performed in keratoconus-afflicted people to to treat vision loss through strengthening the collagen bonds in the cornea. While cross-linking surgery (or other types of eye surgeries) can aid people with progressive vision loss likely to eventually lead to legal blindness, it may not be advisable in a pregnant woman who is not yet considered legally-blind. Indeed, it may be a good idea for a woman in her childbearing years scheduled for cross-linking surgery (or any other cornea surgery) to undergo a pregnancy test a few days prior to the scheduled surgery in order to determine whether that surgery should be postponed until after delivery of the newborn.
Since changes in estrogen and progesterone levels that normally occur during pregnancy can impact the cornea, the eye measurements performed in preparation for corrective cornea surgery can be likewise impacted. Therefore, the vision correction achieved through cross-linking surgery (or any other cornea surgery) may be more accurate if performed after conclusion of the pregnancy (when the fluctuating hormone levels have returned to normal).
Antibiotics and Steroids Prescribed Following Cornea Surgery and Pregnancy
Infection is a rare complication of cornea surgeries (including cross-linking surgery). However, people considered at higher risk of developing a cornea infection are often prescribed a course of antibiotics (or are prescribed antibiotics to treat a diagnosed infection).
While most antibiotics are not associated with increase risk to fetal development, Tetracycline is not recommended for use in pregnant women after the 15th week of pregnancy (per the Mayo Clinic). Likewise, steroids often used to decrease inflammation after surgery are also not recommended in pregnant women (due to the increased risk to fetal development linked to steroid utilization).
Vision loss can be anxiety-producing during pregnancy, and especially if you are coping with progressive worsening of vision due to keratoconus. By visiting an office of the Precision Keratoconus Center after you receive a confirmation of your pregnancy, that anxiety may be alleviated through developing a long-term plan of action to improve your vision.