P4P & SFM Eyes in Pregnancy: What Can Happen?
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[00:00:00] Dr. Alicia Power: On today's podcast, we speak with Dr. Amaka Eneh, who's an ophthalmologist here in Victoria, BC. She has a specialty in glaucoma, but she does manage all people with eyeballs regardless of age or gender or pregnancy status.
[00:00:14] Today we talk a little bit about common issues that can come up with your eyes and your vision in any pregnancy. And we also drill down into some more specific medical issues that the pregnant person may have that might need more monitoring, including diabetes in pregnancy, glaucoma in pregnancy, and a few things that can come up rarely in pregnancy, but are important to know about. One of her pieces of wisdom is if you know that you have a chronic medical issue that affects your eyes, prevention is very important.
[00:00:41] So going to see your provider when you're thinking of becoming pregnant or when you first find out you're pregnant, if it wasn't necessarily planned. Also just a reminder, we've got a great free handout on preparing for pregnancy. And one of the things that we do discuss in that is making sure that any medical conditions that you have, have been as stabilized as possible. So [00:01:00] if you want that, check it out in the show notes and we'll get to the podcast right after this quick reminder.
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[00:01:54] Dr. Alicia Power: I'm so excited to introduce everybody to Dr. Amaka Eneh. She is an [00:02:00] ophthalmologist here in Victoria, BC, and she has come to talk to us all about eyeballs in pregnancy.
[00:02:05] So Amaka, why don't you start off by telling us a little bit about yourself and what got you into this field, and then we'll talk around pregnancy related eye stuff.
[00:02:14] Dr. Amaka Eneh: Hi Alicia, thank you for having me. This is, this is exciting. How did I get into eye related stuff? So I think I was 13, I was playing a video game, and I decided I wanted to be a surgeon. And that was how this whole journey started. And at first I thought I'd be a heart surgeon, but when I got into medical school, I went to Queen's. I saw the light, so to speak, and fell in love with ophthalmology right during the lectures. Everything seemed to just intuitively make sense.
[00:02:43] I think I was drawn to it intellectually. The eye is a very aesthetically pleasing organ, actually quite a unique organ to work on, and so I was very lucky to get a residency position right there at Queen's in my alma mater. And so nine years later, I [00:03:00] was an ophthalmologist looking around, not quite ready to settle.
[00:03:03] And I heard of this opportunity on an island on the other side of the country, where they, a colleague of mine needed some time to herself to raise her kids. And so I flew out here in 2016 for one year to do a locum for my colleague Olivia Dam. Seven years later, I turned my life around to live on the island.
[00:03:24] And in that process also did a Glaucoma Fellowship and started my practice on April 1st, 2020 in the middle of a pandemic and it's been quite the adventure. And so when I'm not doing this, I'm either playing with my little cat, Pavlova, or I'm also heavily involved with Ballet Victoria as a student, as well as a volunteer and board member. And I love to paint and hike, so I stay busy.
[00:03:51] Dr. Alicia Power: Very cool. One I love that you call the eyeball an aesthetically pleasing organ. I think that is hilarious. You don't hear that very often. People [00:04:00] describing the organs on which they work, love that . And yeah, I know the lovely Dr. Dan. So you, you were very kind to give her some time to her family. That's wonderful.
[00:04:11] And then the other thing is glaucoma. We often don't hear about, in pregnancy, we vision these old people with glaucoma, but in fact, you and I currently share a lovely patient who is pregnant with glaucoma, so it actually is quite appropriate that we're doing this today. So why don't we start off around just the general changes that can occur within eyes and all of the things that serve the eyes, nerves, vessels, etc. when we are pregnant, we'd love to hear about what are the kind of common and maybe the less common issues that can come up and how we can manage them or what we should be doing around them. And then we're going to go into a little bit more of the certain medical conditions that may predispose people in pregnancy to be needing more surveillance or care of their eyes. Does that sound reasonable?
[00:04:57] Dr. Amaka Eneh: Absolutely. That sounds like a great [00:05:00] plan. In the past, we, you're absolutely right in that my general patient population in an eye doctor's clinic is not of pregnancy age. However, with reproductive technology, the way it is, we are getting older patients who are pregnant and we, and, it is, even though rare, it is common, it is possible to have, even I'll say that again, even though eye conditions in young people are rare, there are many congenital and juvenile eye conditions. So it is very possible to have, to be pregnant and also have a chronic eye condition. So we'll just start with the outside of the eye. We may have all noticed that during pregnancy, there can be fairly normal changes to the coloration of the skin around the eyes.
[00:05:45] There can be changes to blood vessels, exposed blood vessels around the nose, etc. Drooping of the eyelids has been reported, although I don't see that quite so often. Next, we get into this really exciting realm of what happens to your [00:06:00] prescription when you're pregnant. There has been a lot of conventional wisdom that women who are nearsighted, so they're myopic, meaning they can read okay, but when they have to see far away they need glasses, that's what myopia is, that there has been a lot of wisdom that it worsens during pregnancy.
[00:06:19] However, there's also now a lot of debate about it. There was an exciting study out of Spain looking at over 10, 000 women that showed that in some cases, actually, your myopia improves. Your nearsightedness improves during pregnancy. So your vision gets better. And I have a personal story about this.
[00:06:35] It made me laugh. So my mom, who was quite young when she had me, said that her vision improved when she was pregnant and it actually stayed improved and I always say, you're welcome mom, that was indication number one of what my future job was going to be. And some of the debates there on that is, is it okay to do LASIK corrective surgery when you're pregnant? And we can get into that if you like.
[00:06:58] Into the back of [00:07:00] the eye. And this is particularly important for people who have diabetes. So if you're a woman with diabetes and you get pregnant, you may need more more frequent surveillance for diabetic eye disease. I have seen the occasional woman who during vaginal labour, sustains bleed in the retina, and there was a recent study talking about do we encourage women who've had retinal detachments, then, to have C sections?
[00:07:26] The general opinion was, no, let's just do what's right for the woman, and if there is a problem, we'll fix it, but the chances of having a problem in the retina are actually quite slim, and I do get those referrals. Happy to see them. Yeah.
[00:07:38] Dr. Alicia Power: And I certainly often, if somebody has a history of eye concerns, we'll ask them to see their ophthalmologist and ask specifically that question around, is it safe to push in labor?
[00:07:48] I think there's a couple of reasons not to, but certainly doesn't seem like many reasons to avoid a vaginal delivery for that reason, and also we can also use to minimize the amount of [00:08:00] pushing somebody has to do in labor. We can also use an epidural and we can allow their body to continue bringing baby down for longer after they're fully dilated. And so that pushing period is actually less. So that's something that sometimes we'll do just to help to mitigate any small risks that there might be. If the pregnant person's hoping for a vaginal delivery and their ophthalmologist is a-okay pushing, we can minimize the amount of pushing as much as possible. So!
[00:08:24] Dr. Amaka Eneh: Great, that's great. I totally agree. I think that if we want to do what's right for the lady holistically and the baby and the vaginal delivery is what's chosen it, I would rather that and the risks of retinal problems are so rare or is so low. Now a couple more little things that, that came up certainly with preeclampsia, yeah. So your blood pressure going up can actually come with certain eye symptoms as well, decreased vision. In the realm of the inflammatory conditions that are non infectious, so we're talking multiple sclerosis, and also a newer related condition called NMO or [00:09:00] neuromyelitis optica. There's a general agreement that actually there may be some improvement or some relief from symptoms during pregnancy. There's that.
[00:09:11] Dr. Alicia Power: Do you think that's because of the general immune suppression of pregnancy? So that we're not having that autoimmune kind of ramp up? Because we know immune, like our immunity is, postpartum, the lowest it'll ever be, but certainly in pregnancy, it's decreased. And so potentially for those kind of more autoimmune type disorders, there would be less immunity attack, attacking oneself. I'm very scientific.
[00:09:36] Dr. Amaka Eneh: That's one of the predominant theories. That's one of the predominant theories, and it makes sense to me as well just thinking through it. Yeah.
[00:09:44] Dr. Alicia Power: Awesome. And do you see any changes? Because everything swells in pregnancy. Anyone who's been pregnant is well aware of that. So do you see any changes around that feature? So any changes in terms of kind of swelling around the nerves innervating the eyes, or the optic [00:10:00] nerve or blood vessels? Is that kind of the thought around maybe the changes in that myopia or lack thereof?
[00:10:06] Or do we know of, and is there any kind of, anything that you see?
[00:10:10] Dr. Amaka Eneh: Yeah again, the population that I see if you're pregnant and you're seeing me as a glaucoma specialist or general ophthalmologist, you really have, you have either diabetes or glaucoma, which confounds the whole picture. There are a lot of studies looking at all of the parameters of the front part of the eye, which is the refractive part of the eye. So yes, there can be changes even to the shape of your cornea, which can change your your need for glasses higher or lower.
[00:10:42] I think we're still theorizing about the reasons for all of that I don't think there's definitely consensus on exactly why certain changes occur, but it makes sense to me that if everything is swelling, like you mentioned, pregnancy affects every part of your body. The fascinating thing about the [00:11:00] human eye, and I'm going to nerd out about this, please forgive me, is there are so many parts of the eye that need to be clear in order for light to get all the way through to the back of the eye.
[00:11:09] Clarity is maintained with hydration, so your corneas exactly 70 percent hydrated. Your lens is exactly 78 percent hydrated with very little error back and forth. And so if there's any swelling at all, you can imagine that the shape of your cornea, as well as the clarity of the cornea and the lens would change.
[00:11:28] That itself would make a difference. In addition, the lens inside the healthy, young human eye is suspended in a bag that's held like with ligaments. It's almost like a hammock. So if those ligaments start to stretch you can imagine that the hammock would sag more and that minuscule changes of the position of the lens inside the eye can spread to big changes to your glasses prescription. So there's a few reasons for that.
[00:11:57] Dr. Alicia Power: And do you find that people have to change their [00:12:00] prescriptions after pregnancy? Maybe their vision doesn't change during pregnancy, but as the result of that swelling and that hammock lagging, as you say do you find that people actually, after being pregnant some people have bigger shoe sizes after they're pregnant because of the swelling, right?
[00:12:13] Do you ever find that's an issue with kind of that post pregnancy life, is that you then require glasses when you didn't before, or you were on the verge before?
[00:12:23] Dr. Amaka Eneh: Yeah, I don't prescribe glasses anymore so, I don't quite see that population. Anecdotally with my mom, she says her glass prescription remained very low throughout life after me. When I do talk to my ladies who have had, so these are probably ladies in their 60s and 70s who've had babies in the past. They don't tell me that their prescription changed dramatically afterwards. So I don't think that's a big concern. Generally speaking, I would recommend, if you're really, if there was a dramatic change for you, sure, get a cheap pair of [00:13:00] glasses, use them during pregnancy and see what happens.
[00:13:02] Yeah, it's so variable and so individual in that sense
[00:13:06] Dr. Alicia Power: As most things are in medicine. Isn't it true?
[00:13:09] Dr. Amaka Eneh: There's no rules. Just no rules...
[00:13:11] Dr. Alicia Power: Ish!
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[00:13:12] Dr. Alicia Power: Okay, so we've talked about some general changes that you might see in pregnancy. So maybe a slight shift in your prescription, maybe kind of some changes around your eyes to the skin, to the kind of the facial features, etc.
[00:13:25] And then we've briefly touched on a few of the medical conditions, which may need a little bit more monitoring. I'm wondering if we can go a little bit deeper into some of those specifically for those people who are listening, who either have them or care for those who don't. And what are the indications of how often should they be monitored? And what are some of the signs that we as care providers should be aware of to ask our patients, or patients should be aware of to speak to their care providers about? I wonder if we can talk about probably one of the more common things that we would see as care providers: people with diabetes, pre-existing diabetes, so whether that's [00:14:00] type 1 diabetes, so an earlier onset diabetes, generally always have to take insulin, versus type 2, which is usually that later onset sometimes can not be on insulin, but other medications such as metformin, etc. What are the changes that you might see, or what are the different needs of monitoring during pregnancy would we be looking for with, for people with diabetes in pregnancy?
[00:14:24] Dr. Amaka Eneh: This is such an important topic because, again the age limit for pregnancy has expanded thanks to reproductive technology, and again, we're overlapping the people who have diabetes type 1 or type 2.
[00:14:36] Generally in ophthalmology, there, we don't make very big distinctions between Type 1 and Type 2 in terms of treatment, in terms of what I'm looking for in the back of the eyes of a person with diabetes, if you're, if you have diabetes. There are slight differences in when we start screening Type 1 versus Type 2, but not otherwise.
[00:14:56] Diabetic, so most of the diabetics I see, thank [00:15:00] goodness don't have a lot of changes in the back of their eyes. We're looking for little tiny bleeds in the back of the eye, changes to the shape of the blood vessels in the back of the eye, sometimes swelling in the macula, which is a very central part of your retina, which is where the light is collected and sent to the brain.
[00:15:17] In more extreme cases, if there, if the diabetes is more severe, you can start the development of extra blood vessels, we call it neovascularization. You would think extra blood vessels is a good thing, right? More blood, great! More oxygen, better health. Unfortunately not! The eye is a very special organ and its blood vessels need to be sheathed exactly a certain way so that they don't leak and cause what we call medial opacities, don't cloud up this clear globe that the eye needs to be. So unfortunately, these new blood vessels that grow are very leaky and they're prone to break and bleed into the eyeball. You can imagine, think of your eyeball like a snow globe. I use [00:16:00] this analogy every single day with my patients.
[00:16:01] If the snow globe is left on the table and the snow is settled, you can see right through. As soon as you start to shake things up, you can't see anything anymore. An eye that has had bleeding is like a snow globe that's had everything shaken up. So in all of my patients who have diabetes, I'm looking for these particular signs.
[00:16:22] If you just have a few spots of hemorrhage, we can just monitor that, no problem. If you are getting into the neovascular side of diabetes with the new blood vessels now we're looking at either laser or injections directly into the eyeball.
[00:16:38] I don't know if that has been mentioned before in your podcast. I'm sorry to scare people. Maybe we should put a little warning in there beforehand. And absolutely, so the current recommendations are that when, the most important thing to do is if your pregnancy is pre planned, come in and let us know you're [00:17:00] thinking of getting pregnant. The more we know about you beforehand, the better, right?
[00:17:04] And if you have just very little diabetic retinopathy or none at all, you can just monitor. Maybe every three months, maybe every six months. All good. If you're in that category of patients who are, who's already getting injections into their eyeball for neovascularization, we've done a lot of research and a lot of those medications that we inject are still safe for injection ongoing.
[00:17:27] There's some evidence that maybe diabetic retinopathy worsens during pregnancy, but I felt that the data wasn't that strong for it. If I can leave your listeners with a couple of messages about diabetes, number one if it's a pre planned pregnancy, let us know right away. It's great if we can, know ahead of time and it's important to monitor. Some women need more frequent monitoring than average, but most women can just be, whatever frequency they were before can be continued. One [00:18:00] last little thing that happens with diabetes is if you have a very high, a spike in your blood sugars. Again, remember we talked about the clarity of the organs, of the little parts of the eyeball, the cornea and the lens. Sometimes because of the high blood sugars, convoluted sort of biochemistry, but there's more water that goes into that lens. Okay, more water in a lens, it's supposed to have a very specific percentage of water, any more water and the lens gets cloudy.
[00:18:25] Sometimes people will come in with cloudy vision that started hours ago, or a few days ago. And I look in and everything looks reasonably okay. But when you re look at the thickness of that lens, boy, it's a lot thicker than it used to be.
[00:18:39] We don't tend to treat that with surgery. It's not cataract surgery we do there. We just work really hard with the internist to bring the pressure down and the body normally can pump out all of that excess fluid and return vision to normal.
[00:18:53] Dr. Alicia Power: So interesting. For those of you out there listening, we actually have a free kind of handout on preparing for [00:19:00] pregnancy. Like I said, prevention is worth an ounce, what is it? An ounce of prevention is worth a pound of cure. But certainly like preparing yourself if you are pregnant, certainly if you have some ongoing medical disease, make sure that you talk to your care providers, make sure that you seek out help and advice and feel free to download our preparing for pregnancy handout and we'll put in the show notes below.
[00:19:19] So thank you. So that was around diabetes. Let's talk about glaucoma now. Can you give our listeners just a very brief definition of what is glaucoma and then what do you need to do as a care provider and what does the patient need to do to monitor that through pregnancy?
[00:19:32] Dr. Amaka Eneh: Absolutely, a subject that's so close to my heart. And just a little plug, I think it's only 4 percent of patients who go to a GP's office have glaucoma, whereas 80 percent of my patients have glaucoma, so I'm passionate about spreading the word any way I can. Glaucoma is a disease of the optic nerve, which is the cable that connects the eye to the brain. When that cable is affected, people typically, although there are exceptions, [00:20:00] start to lose peripheral vision. So it's not your central vision, it's your side vision that goes. And it's very silent. Glaucoma is a silent thief of sight. Most patients would not pick up visual field changes really until the very bitter end.
[00:20:17] The way we, the only thing we can do for glaucoma is control it. If you start to lose fields, I cannot bring back any of the fields you've lost, but I can certainly try and prevent you from losing any further. And the only way we have to do that right now is by lowering your eye pressure. And it's very easy for glaucoma specialists to get somewhat obsessed with the eye pressure, which has led to the mistaken understanding that glaucoma is high eye pressure.
[00:20:47] It's not, okay? You can have low, technically low pressure and still have glaucoma because it's damage to that nerve. No matter what your pressure is though, if you have damage to the nerve and if I feel like it's getting worse, [00:21:00] all I can do is decrease that pressure further. That is done using either drops, laser therapy or surgery.
[00:21:07] And while most of us think of glaucoma as a disease of an older population, and that is true, your risk of glaucoma does go up after age 70. We know that children can be born with glaucoma. You can get glaucoma as a young person. There's congenital glaucoma, juvenile glaucoma, traumatic glaucoma, which you get after a trauma. Glaucoma that results from medication use such as steroids, glaucoma associated with inflammatory conditions like ankylosing spondylitis, etc. Really, I can see glaucoma in anybody of any age, and certainly also in our pregnant population. The data about what drops are safe is minimal because it's not typically easy to do experiments on women who are pregnant.
[00:21:56] And so all of the data is case reports [00:22:00] or small cohorts of women who've been followed along, and the reports usually say we tried, this medication, or this lady was pregnant without realizing, and she was on this medication, and the baby was okay. Or the baby was not okay, and there was there was, various problems.
[00:22:16] The lady is pregnant with glaucoma, there are some medications which are a little bit safer than others to use. There's no medication that's 100 percent safe. Because we just don't have those studies to show that. So a couple guidelines then under those circumstances. Number one, again, the sooner we find out about your pregnancy or your desire to get pregnant, the better.
[00:22:38] We might choose to change out your drops at that point. Number two, when, if you do have to take drops you can put the drop in and then block your tear ducts for two minutes. And that is by, done by using your pinky finger, placed against the inside corner of your eyes. Now it's not on the nose, it's a little bit further back. Right where the two eye, the upper and eye, [00:23:00] lower eyelids meet, there's a little grain of rice. That's the tube that connects your eyeball to the back of your nose. You block that tube for two minutes after you put a drop in and close your eyes for those two minutes. It minimizes how much of the drop gets into your body.
[00:23:16] The patient that you and I share is continuing on her drops, right? Happily, no problems at all. There's reasonably good data to even question the need for drops during pregnancy because glaucoma is a, generally speaking, with exceptions, a slow going disease. Sometimes it's okay to stop a drop during pregnancy or decrease the number of drops you're using. Of course, please do this in conjunction with your health care provider, please don't surprise me by telling me that you haven't been taking your drops for the last nine months that's really hard on my coronary arteries, but certainly happy to discuss that possibility.
[00:23:55] The other exciting possibility is just laser. So not LASIK, we're not talking about [00:24:00] vision correction, we're talking about the multiple types of lasers that I can use to bring down eye pressure without the use of drops, and that's a great option as well.
[00:24:08] It is incredibly rare that we would need to move on to glaucoma surgery when you're pregnant. Of course, there are case reports and they were actually reassuring and it can be done for sure. We would get an anesthesiologist involved. It would be a bigger production than if you were not pregnant. But it certainly can be done with a lot of help.
[00:24:30] Dr. Alicia Power: Awesome. A risk benefit discussion for sure.
[00:24:33] Dr. Amaka Eneh: Absolutely.
[00:24:34] Dr. Alicia Power: And then in terms of monitoring, so presumably they're going to be regularly, I'm making this up, seeing you or a colleague for pressure checks and or peripheral vision checks to ensure that's not worsening.
[00:24:48] Dr. Amaka Eneh: Yeah, perfect. Alicia, you could do this.
[00:24:50] Dr. Alicia Power: No, I couldn't. Not much grosses me out, but I'm going to be honest. Eyeballs? Although aesthetically pleasing, gross me right out.[00:25:00]
[00:25:00] Dr. Amaka Eneh: Yeah when you look at an iris through a microscope, it's really something to behold.
[00:25:06] Dr. Alicia Power: It's more the needles, thinking of the needles in the eyeballs that gross me out.
[00:25:09] Dr. Amaka Eneh: The needle, I forgive you for that, for sure. So I would keep regular monitoring. I would not increase my frequency of monitoring if you have little or mild glaucoma, I would have a discussion and this is me being ultra careful, but I would have a discussion about putting even numbing drops in your eyes before taking eye pressure. So the gold standard way of taking your eye pressure involves me putting numbing drops in your eyes and it's not the puff of air.
[00:25:37] There is no puff of air in my office. It is a device that actually touches the eyeball and because it touches the eyeball, we have to numb you first. So I have that discussion with my patients each time. This is a minuscule drop. Of numbing agent. It has not, I haven't had a problem with it. Are you, number one, are you comfortable going forward?
[00:25:58] And number two, [00:26:00] we can just, if you are comfortable, we can just block your tear ducts and I whip out my phone and we just use the timer for two minutes and everything's good. I would take pressure and then, yeah, there's, there really should be no barriers to getting scans of your optic nerve and getting your visual field done.
[00:26:14] Obviously, we'll be very careful to make sure you're positioned comfortably while you're doing your visual field because it can be a two to ten minute kind of test. And yeah, just continue to monitor. Before, during, and after labor.
[00:26:27] Dr. Alicia Power: Perfect. And we'd spoken around preeclampsia earlier. Now this is when our blood pressure goes up, and that blood pressure can affect visual changes as one of the symptoms of preeclampsia.
[00:26:39] So pregnant people often will talk about having spots in their vision or changes in their vision when their blood pressures are quite high. Now I don't think any of them would come see you with those changes of vision because generally if you're having those you're probably bad enough to be in the hospital, and we would be managing blood pressure.
[00:26:56] But one other common thing that people [00:27:00] often have that can get worse in pregnancy is migraines. And some people have visual changes associated with their migraines and sometimes people have new migraines in pregnancy. So would love some advice around people who have new vision changes, either like little wavy things in their eyes or they feel like their vision is changing or spots in their eyes.
[00:27:23] Obviously, talk to your care provider about it. We would do your blood pressure and make sure it's not associated with anything like that. But from an ophthalmologist point of view, what is your advice for people who are having new visual changes, and that we've ruled out a high blood pressure situation, would you suggest that they go to an optometrist, ophthalmologist, get their vision tested? What would you recommend that people do?
[00:27:44] Dr. Amaka Eneh: That's a great question. I think I would also add a blood sugar test to that whole situation because if there's gestational diabetes and the blood sugars have gone up and you've created a swollen lens, that can certainly change your refractive error, which is the [00:28:00] fancy word for your need for glasses, the prescription on your glasses.
[00:28:04] Once all of that has been ruled out, absolutely beneficial to see an eye care provider and increasingly in our health care environment, the optometrist is becoming my family doctor colleague in that they do a lot of our screening. I have, very close and strong relationships with almost every optometrist here in the city, and they are really well trained at screening for eye conditions for sure.
[00:28:29] If you have an ophthalmologist who is already in your care. You can absolutely call their office. We want to know. Often times, the answer is reassurance. Everything will get better. It will be beneficial to have an eye exam. I would love to see that eyeball if there is problems. If there are problems.
[00:28:47] I would love to see the, I would love to examine the eye if there are problems. The most important thing is, don't ignore the problem. I would rather say to you, oh, don't worry, this is normal, [00:29:00] it'll go away. Then say to you, I wish you had come in yesterday or last week.
[00:29:06] Dr. Alicia Power: Yeah. And then there's a couple of other medical conditions that can come up in pregnancy. Thankfully quite rare that can necessitate the need for an urgent ophthalmology consult. So one of them is shingles or zoster in a certain distribution, so generally if it's coming from your scalp over your forehead, through to your eye, through to the tip of your nose that we worry that you can actually have lesions on your eye, ball, front, I don't know the terminology.
[00:29:36] So that would certainly be one of those times that we as providers, if we saw that or suspected that, would call our friendly ophthalmologist and ask for them, for you to be seen quickly. And then the other thing is Bell's palsy, which is it's a nerve issue that can lead to that kind of ptosis, that dropping of your eyelid, etc. I don't think that, correct me if I'm wrong, is actually dangerous for vision or for [00:30:00] eye, but certainly it is around the area of the eye sometimes we might suggest, just seeing your friendly optometrist for, make sure that everything is well. Is there anything else that you can think of that would necessitate a more urgent or a more urgent eye check?
[00:30:15] Dr. Amaka Eneh: Very rare. That's a great, that's a great list of possibilities. We've touched upon a little bit upon multiple sclerosis, neuromyelitis optica, and optic neuritis. In terms of, I just wanted to make one little comment about zoster. Zoster knows no boundaries and can go into every part of the eyeball all the way from front to back. Absolutely want to see anybody who's got zoster in that distribution. With Bell's palsy, it's not fun to walk around with one eyelid droopy, also known as ptosis. And I, I wouldn't treat that ophthalmologically. I would rely on my internist and neurologist, GP colleagues to, to treat that. Bell's palsy in itself does not, does not harm the eye in a, [00:31:00] in an adult. Now if, now, it's very different though if you are a child. If you are a child less than age 14 and you have a droopy eyelid, that is almost an emergency. We must fix that before the connection to the, between the eye and brain break down permanently. Because that connection is still being built at that time. So if you're an adult with drooping eyelid it's an inconvenience, we need to treat that, it's not going to harm your eyes.
[00:31:24] Dr. Alicia Power: So we've talked a lot about pregnancy, but we also have a lot of listeners who are breastfeeding or pumping or doing chest feeding. So do you have any kind of, are there any issues that might come up during that time that you wanted to let people know about or discuss, including kind of medications or drops that might be used during that time?
[00:31:41] Dr. Amaka Eneh: Absolutely. So some medications, even some eye drops will cross over into breast milk. So again a lot of this, a lot of similar discussions to when a woman is pregnant entering glaucoma treatment, we actually do switch out some drops. So some drops that are a little bit safer in pregnancy are a little bit more dangerous for the [00:32:00] baby. So we would switch them out. There's that.
[00:32:03] There's some evidence that the peak level of a medication in your breast milk happens between 30 minutes and 120 minutes after you take the drop, so I know this is really hard when your baby is young and you're feeding on demand, but theoretically if you could breastfeed your baby and then immediately after put the drop in that does minimize your risk, blocking your tear ducts.
[00:32:29] Dr. Alicia Power: I was gonna say with your tear, I'm blocking my tear duct right now.
[00:32:32] Dr. Amaka Eneh: Yeah, exactly as you hold the baby and yeah, blocking your tear ducts works as well And a similar discussion can be had about the gross eyeball injections that we talked about. We've actually looked at the rate in which some of those medications elude into breast milk as well. More discussions for you to have with your ophthalmologist if you're in that situation.
[00:32:53] Dr. Alicia Power: Thank you. So that was a jam packed podcast, I'm going to say. So we've talked about general changes that you might [00:33:00] notice in pregnancy regarding your eyes and your vision. We've talked specifically around people who have pre existing diabetes, be that type 1 diabetes or type 2 diabetes, and I learned something new, that higher blood sugars can make quite immediate visual changes. So that's something that I learned today that I didn't know. So thank you very much for that. We also talked about some other specific, maybe a bit more rare. So we talked about glaucoma and pregnancy and lactation. And we also talked about some of those things that can come up that might necessitate an urgent optometry or ophthalmology eye exam.
[00:33:33] So thank you so much for joining us today. The eye is a Very beautiful organ and very useful to us. So we want to keep it healthy just like everything else. So really appreciate your insights and knowledge and your willingness to chat today about this.
[00:33:48] Dr. Amaka Eneh: Oh, my pleasure. This was fun, Alicia. Thank you so much for having me.
[00:33:52] Dr. Alicia Power: Take care. Have a great day.
[00:33:53] Dr. Amaka Eneh: You too!
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