I do not no of any human studies on the effects of Beta-Blockers on pregnant humans. Do you know of any patient related complications? Any cautions? What criteria should be used to determine if a woman with gluacoma under topical beta-blocker treatment with Betagen should have laser surgery in lieu of continuing treatment? My wife is in her fourth month so far , with no known problems. She was on progestoron treatment the first tri-mester. Thanks
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Answered by Richard E. Gans, M. D. (xx102@ofcn.org)
In general, all medications must be cautiously evaluated prior to use during pregnancy. It is often difficult to determine the safety of a medication for use in pregnancy, because it is virtually impossible to run clinical trials ethically. One would not want to run an "experiment" that could affect the health or outcome of a mother and fetus during pregnancy.
Despite this, I am told by OB/GYN colleagues of mine that beta blockers have been used safely in pregnancy in the past.
Although there is some systemic absorption of medication from eyedrops, there are ways to limit the amount of medication that gets into one's system. Punctal occlusion is such a technique. When administering the eyedrop, the index finger is pressed firmly in the nasal corner of the eyelid, on the side of the nose. The finger is held there for 1-2 minutes after the drop has been instilled. This maneuver blocks the tear drainage duct so that excess medication runs out of the eye, rather than through the nasolacrimal duct and into the system.
Laser trabeculoplasty is a surgical procedure used to control glaucoma. In general, ophthalmologists usually employ medications prior to considering surgery in the treatment of glaucoma. Because there is the potential for harmful effects from some medications, sometimes laser is used in order to free the patient from the need to take these medications.
Although this might sound like an endorsement of laser in this situation, several other factors must be considered. Laser trabeculoplasty can only be performed once or twice (depending on how it is done) for each eye. It is not a permanent cure of the glaucoma. It's effects only last for a few years. Medication may still be necessary after the laser. It tends to be more effective in older individuals. There is some risk to any invasive procedure. Sometimes, the pressure in the eye goes up rather than down, after laser trabeculoplasty. Thus, most ophthalmologists reserve laser trabeculoplasty for older patients who fail to respond to conventional medical management.
That is not to say that laser would not work in this situation. It might. But one must always be aware of the risk/benefit ratio in any course of treatment. Is the risk of taking a beta blocker during pregnancy greater than the risk of laser surgery in someone who will most likely have to deal with glaucoma for 30-50 more years? I'm afraid no one has the answer to that question.
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Copyright, 1994. Richard E. Gans, M.D.
A RICHARD E. GANS, M.D. 11
A A OFCN Primary Sysop, The Eye Clinic 111
AAAAA xx102@ofcn.org 11
A A A C A D E M Y O N E 1111
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