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102 102 EW REFRACTIVE Pregnancy continued from page 100 Dr. Yoo said that accommoda- tion can also be affected by preg- nancy, yet another reason to postpone any refraction work or sur- gery. During lactation, both accom- modative insufficiency and paralysis have been reported, she added. "There have even been reports in the literature about patients who discovered they were pregnant after they had already gone through re- fractive surgery. These women were followed for 6 months or more, and a significant percentage had regres- sion," she said. "Women should wait until they're finished breastfeeding," she said. "We want to treat a stable re- fraction, whether it's for ICLs, LASIK, or photorefractive keratec- tomy. Most refractive surgeons will advise against any kind of elective refractive surgery if a patient is cur- rently pregnant or actively trying to get pregnant." Dr. Chu added that because some of the refractive changes are metabolic in nature, healing can also be impacted. "There's a slightly increased chance of scarring," he said. Treatment differences Neither Dr. Yoo nor Dr. Chu alter the informed consent if the patient is postpartum, "but I do have to ask if she's pregnant or nursing," Dr. Yoo said. In some cases, she'll administer a pregnancy test. In general, how- ever, the actual treatment is no more complicated. "What can be tricky is the tim- ing of the surgery," she said. "Most refractive changes seem to occur in the latter half of pregnancy, so I pre- fer to wait up to 6 months after she's given birth before scheduling sur- gery." Further, there is no evidence that if a woman has had transient refractive changes in one pregnancy that it will recur in subsequent preg- nancies. Nor is there any evidence to suggest refractive surgery (implant or laser vision correction) will pre- vent future transient changes in sub- sequent pregnancies. "Post-surgery, we do use some medications, albeit eye drops with very minimal chances of causing an adverse systemic reaction," Dr. Yoo said. "But some of the steroid drops and cyclosporine A are in different classes in terms of risk for pregnant women." All in all, refractive surgeons will best serve their patients by rec- ommending delaying refractive sur- gery until well after breastfeeding is complete. EW Editors' note: The doctors mentioned have no financial interests related to this article. References 1. Barbazzetto IA, Pizzarello LD. Ocular changes during pregnancy. Compr Ophthalmol Update. 2007 May-June;8(3):155-67. 2. Bilgihan K, Hondur A, Sul S, Ozturk S. Pregnancy-induced progression of keratoconus. Cornea. 2011;30(9):991-4. 3. Razeghinejad MR, Tai TYT, Fundemberg SJ, Katz LJ. Pregnancy and glaucoma. Surv Ophthalmol. 2011;56:324-335. Contact information Chu: 952-835-1235, yrchu@chuvision.com Yoo: 305-326-6322, syoo@med.miami.edu EyeWorld factoid An estimated 153 million people world- wide live with visual impairment due to uncorrected refractive errors (this figure does not include the people living with un- corrected presbyopia) Source: World Health Organization March 2012