Can you have eye surgery while pregnant? Get the answer here
Refractive surgery is most common between the second and fourth decades of life, which matches with the age when pregnancy and breastfeeding occur. This raises the question about the best timing between these very important decisions in life and refractive surgery to become free from glasses. It is important for us to help each patient to find the best option between those two events.
Why pregnancy and breastfeeding play a role when deciding the time of refractive surgery?
Prior to refractive surgery the refraction of the patient should be stable for at least 6 months before surgery. Stability is defined as the absence of a change greater than 0.5 diopters during the last 6 months.
There is extensive clinical evidence stating that refraction may change for a period of time during hormonal changes and therefore around 10-15% of women feel a slight worsening of vision during pregnancy and breastfeeding. The key issue is not the safety of refractive surgery itself, but the effect that hormonal changes have on the eye, particularly the cornea. Pregnancy, breastfeeding, and fertility treatments all involve significant fluctuations in hormones such as estrogen, progesterone, and prolactin. These changes tend to be more pronounced in the second and third trimesters and are usually temporary, resolving after delivery or after breastfeeding has ceased.
In almost all cases this change returns to normal after the hormonal levels stabilize again, however, the timeline for normalization can vary significantly between individuals.
The same principle applies, although less frequently discussed, to breastfeeding. Lactation is associated with elevated prolactin levels and continued hormonal influence on the body, including the eye. It is not uncommon for corneal parameters and refraction to remain slightly altered during this phase.
What is the international consensus of good practice regarding this topic
We do not offer refractive surgery to patients who are pregnant, undergoing fertility treatment, or breastfeeding. In cases where vision has not changed during this period, the patient may be a candidate for refractive surgery after the breastfeeding period (80–90% of women). In cases where there have been changes in vision during these processes, we recommend that the patient wait 6 months to ensure stabilization of the refraction.
Refractive surgery and fertility treatments
Procedures such as ovarian stimulation in in vitro fertilization protocols involve rapid and sometimes high-amplitude hormonal changes. Although the ophthalmic literature specifically addressing fertility treatments is more limited than that on pregnancy, the underlying physiology is similar enough to raise the same concerns. And the best clinical practices are the same as with pregnancy and breastfeeding: we do not offer refractive surgery to women undergoing fertility treatment but there is no contraindication to perform refractive surgery before these treatments, allowing at least 4 weeks of time between the surgery and the start of the fertility treatment.
Medications after refractive surgery
Another aspect occasionally raised is medication exposure. We use topical antibiotics and corticosteroids used after refractive for a month. Although topical drops on the eye have shown minimal systemic absorption, we prefer to avoid elective procedures requiring medication during pregnancy or fertility treatment, and therefore we suggest that the surgery should take place at least 4 weeks before the patient becomes pregnant or would start fertility treatments.
Our team stays regularly updated about this topic and our surgeons are currently participating in developing safety guidelines of refractive surgery during pregnancy. If a patient has any further questions we will be happy to address them.
Selected references (for further reading):
- López-Prats MJ et al. “Influence of pregnancy on refractive parameters and visual acuity.” J Cataract Refract Surg, 2012.
- Zamorano-Martín F et al. “Refractive changes during pregnancy and postpartum.” J Cataract Refract Surg, 2021.
- Efe YK et al. “Effects of pregnancy on corneal biomechanics and topography.” Current Eye Research, 2012.
- Riss B et al. “Corneal sensitivity, tear function and ocular surface changes during pregnancy.” Ophthalmologica, 1981 (classic but still cited).
- Naderan M et al. “Pregnancy and the eye.” International Ophthalmology Clinics, 2013.