Effect of Pregnancy on Preexisting Ocular Diseases
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Diabetic retinopathy
Pregnancy is a risk factor in the progression and severity of diabetic retinopathy. Risk factors forthe progression of diabetic retinopathy include duration of diabetes, glycemic control, and presence of hypertension. The duration of diabetes is one of the most important factors implicated in the progression of diabetic retinopathy. The longer the duration of diabetes, thehigher the chances to develop diabetic retinopathy. Also, a poor glycemic control in terms of higher HbA1c at the time of conception is linked with a higher tendency to develop retinopathy. Blood glucose is also an important determinant in fetal well‑being. Well‑controlled blood glucose levels prior to conception may reduce the risk of spontaneous abortion and fetal morbidity and mortality.

Graves’ disease
Graves’ disease is one of the most important causes of hyperthyroidism in pregnancy. Graves’ disease aggravates in the first trimester and after delivery, but improves in the second and third trimester. Rarely, the fetus can be affected because of the trans placental passage of maternal IgG. Pregnant female with Graves’ orbitopathy is treated in the same manner as in a nonpregnant female. Mothers with active Graves’ disease should be treated with antithyroid drugs because in untreated cases, there is high fetal morbidity and mortality.

Glaucoma
The pregnant glaucoma patient often poses a challenge for the clinician as the risk of glaucoma progression in the mother has to be balanced against the possible teratogenic effects in the fetus. As mentioned earlier, the intraocular pressure decreases during pregnancy. In most cases, lower intraocular pressure means glaucoma improves with pregnancy. The decrease in intraocular pressure has the potential advantage of avoiding the side effects of antiglaucoma medications. Medical management of glaucoma carries a risk to the normal development of the fetus. It is advisable to instill these drugs along with  punctual occlusion to avoid side effects due to systemic absorption. Peripheral vision is also affected during pregnancy. During the last trimester of pregnancy, mean threshold sensitivity of the entire central and regional visual field increases.

http://www.ijo.in/downloadpdf.asp?issn=0301-4738;year=2020;volume=68;issue=8;spage=1526;epage=1532;aulast=Morya;type=2
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