How do you adjust your glaucoma management strategy for pregnant patients who require IOP lowering?

Managing glaucoma during pregnancy is challenging and requires a multidisciplinary approach in collaboration with the patient’s OB-GYN team. Several management strategies can be considered. Initially, close observation with frequent intraocular pressure monitoring and visual function/nerve assessment is reasonable, as some patients experience a natural reduction in IOP during pregnancy. If pressure control is inadequate, I would recommend selective laser trabeculoplasty (SLT) as the first-line intervention.

If medical therapy becomes necessary, alpha-agonists (pregnancy category B) are the preferred topical agents. To minimize systemic absorption, punctal occlusion should be used with each instillation. It is important to discontinue alpha-...

Often in pregnancy, the pressures decrease, especially in milder glaucoma. When pregnancy is recognized, I ask my patients to stop all topical meds and return every 4-6 weeks to check pressures during and after. The effect can last during breastfeeding, using SLT to control until pressures increase.