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Visual acuity changes in retinitis pigmentosa during pregnancy
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269
Visual acuity changes in retinitis pigmentosa during pregnancy Enzo M. Vingolo a, Serena Salvatore b,⁎, Franco Stagnitti c a b c
Department of Ophthalmology, A. Fiorini Hospital (Terracina), Polo Pontino, University “La Sapienza,” Italy Department of Ophthalmology, University “La Sapienza”, Rome, Italy Surgery Unit, A. Fiorini Hospital (Terracina), Polo Pontino, University “La Sapienza”, Italy
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Article history: Received 10 December 2008 Received in revised form 5 January 2009 Accepted 23 January 2009 Keywords: Pregnancy Retinitis pigmentosa Visual acuity Visual function
Most of the information available on the effect of pregnancy on the progression of retinitis pigmentosa, a retinal degenerative disease potentially leading to blindness, is limited to the impressions of the patients [1]. The aim of the present study was to investigate visual function during pregnancy in patients with retinitis pigmentosa to provide recommendations for preconception and pregnancy counseling. Twenty-two pregnant patients with retinitis pigmentosa were enrolled (age range 20–32 years, each patient had 2 functioning eyes). The patients provided written informed consent and the procedures adhered to the tenets of the Declaration of Helsinki. All patients underwent a complete ophthalmologic examination and particular attention was paid to best corrected visual acuity (BCVA), which was assessed at 1 month, 3 months, 5 months, and 7 months of pregnancy, immediately after the delivery, and at 3 months, 5 months, and 8 months post partum. Statistical analysis was performed using the t test. P b 0.05 was considered statistically significant. None of the patients felt they experienced visual changes during pregnancy. Mean BCVA scores were 0.11 ± 0.48 logMAR (logarithm of the minimum angle of resolution) at 1 month; 0.12 ± 0.45 logMAR at 3 months; 0.14 ± 0.45 logMAR at 5 months; 0.15 ± 0.45 logMAR at 7 months; 0.17 ± 0.46 logMAR immediately after delivery; 0.19 ± 0.45 logMAR at 3 months post partum; 0.21 ± 0.44 logMAR at 5 months post partum; and 0.17 ± 0.42 logMAR at 8 months post partum (Fig. 1). There was no statistically significant correlation between visual acuity behavior and pregnancy. The only statistically significant result was the decrease in BCVA between the beginning of pregnancy and
Fig. 1. Changes in visual acuity during pregnancy in patients with retinitis pigmentosa. Abbreviations: BCVA, best corrected visual acuity; logMAR, logarithm of the minimum angle of resolution; PP, post partum.
5 months post partum (P = 0.04). None of the patients experienced pregnancy-specific eye diseases, including pre-eclampsia/eclampsia and cortical blindness. These data indicate that progression of retinitis pigmentosa is not influenced by pregnancy. The only significant result was a slight worsening of visual acuity at 5 months post partum; if truly significant, this may be because all of the patients breastfed their children and might have undergone a depletion of vitamin A and docosahexanoic acid, which are known to play a primary role—although sometimes underestimated—in the management of patients suffering from retinitis pigmentosa [2,3]. In general, women with retinitis pigmentosa should be advised that their visual acuity may worsen with breastfeeding, but that in general there should be no noticeable effect. Women with retinitis pigmentosa should have close follow-up during pregnancy and postpartum vitamin supplementation should be encouraged. References [1] Yoser SL, Heckenlively JR, Friedman L, Oversier J. Evaluation of clinical findings and common symptoms in retinitis pigmentosa. Invest Opthalmol Vis Sci 1987;28 (Suppl):112. [2] Berson EL, Rosner B, Sandberg MA, Hayes KC, Nicholson BW, Weigel-DiFranco C, et al. A randomized trial of vitamin A and vitamin E supplementation for retinitis pigmentosa. Arch Ophthal 1993;111(6):761–71. [3] Berson EL, Rosner B, Sandberg MA, Weigel-DiFranco C, Moser A, Brockhurst RJ, et al. Further evaluation of docosahexanoic acid in patients with retinitis pigmentosa receiving vitamin A treatment: subgroup analyses. Arch Ophthal 2004;122 (9):1306–14.
⁎ Corresponding author. Via Terni 38 E 13, 00182 Rome, Italy. Tel: +39 333 2731581. E-mail address: [email protected] (S. Salvatore).
0020-7292/$ – see front matter © 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2009.01.027
269
Visual acuity changes in retinitis pigmentosa during pregnancy Enzo M. Vingolo a, Serena Salvatore b,⁎, Franco Stagnitti c a b c
Department of Ophthalmology, A. Fiorini Hospital (Terracina), Polo Pontino, University “La Sapienza,” Italy Department of Ophthalmology, University “La Sapienza”, Rome, Italy Surgery Unit, A. Fiorini Hospital (Terracina), Polo Pontino, University “La Sapienza”, Italy
a r t i c l e
i n f o
Article history: Received 10 December 2008 Received in revised form 5 January 2009 Accepted 23 January 2009 Keywords: Pregnancy Retinitis pigmentosa Visual acuity Visual function
Most of the information available on the effect of pregnancy on the progression of retinitis pigmentosa, a retinal degenerative disease potentially leading to blindness, is limited to the impressions of the patients [1]. The aim of the present study was to investigate visual function during pregnancy in patients with retinitis pigmentosa to provide recommendations for preconception and pregnancy counseling. Twenty-two pregnant patients with retinitis pigmentosa were enrolled (age range 20–32 years, each patient had 2 functioning eyes). The patients provided written informed consent and the procedures adhered to the tenets of the Declaration of Helsinki. All patients underwent a complete ophthalmologic examination and particular attention was paid to best corrected visual acuity (BCVA), which was assessed at 1 month, 3 months, 5 months, and 7 months of pregnancy, immediately after the delivery, and at 3 months, 5 months, and 8 months post partum. Statistical analysis was performed using the t test. P b 0.05 was considered statistically significant. None of the patients felt they experienced visual changes during pregnancy. Mean BCVA scores were 0.11 ± 0.48 logMAR (logarithm of the minimum angle of resolution) at 1 month; 0.12 ± 0.45 logMAR at 3 months; 0.14 ± 0.45 logMAR at 5 months; 0.15 ± 0.45 logMAR at 7 months; 0.17 ± 0.46 logMAR immediately after delivery; 0.19 ± 0.45 logMAR at 3 months post partum; 0.21 ± 0.44 logMAR at 5 months post partum; and 0.17 ± 0.42 logMAR at 8 months post partum (Fig. 1). There was no statistically significant correlation between visual acuity behavior and pregnancy. The only statistically significant result was the decrease in BCVA between the beginning of pregnancy and
Fig. 1. Changes in visual acuity during pregnancy in patients with retinitis pigmentosa. Abbreviations: BCVA, best corrected visual acuity; logMAR, logarithm of the minimum angle of resolution; PP, post partum.
5 months post partum (P = 0.04). None of the patients experienced pregnancy-specific eye diseases, including pre-eclampsia/eclampsia and cortical blindness. These data indicate that progression of retinitis pigmentosa is not influenced by pregnancy. The only significant result was a slight worsening of visual acuity at 5 months post partum; if truly significant, this may be because all of the patients breastfed their children and might have undergone a depletion of vitamin A and docosahexanoic acid, which are known to play a primary role—although sometimes underestimated—in the management of patients suffering from retinitis pigmentosa [2,3]. In general, women with retinitis pigmentosa should be advised that their visual acuity may worsen with breastfeeding, but that in general there should be no noticeable effect. Women with retinitis pigmentosa should have close follow-up during pregnancy and postpartum vitamin supplementation should be encouraged. References [1] Yoser SL, Heckenlively JR, Friedman L, Oversier J. Evaluation of clinical findings and common symptoms in retinitis pigmentosa. Invest Opthalmol Vis Sci 1987;28 (Suppl):112. [2] Berson EL, Rosner B, Sandberg MA, Hayes KC, Nicholson BW, Weigel-DiFranco C, et al. A randomized trial of vitamin A and vitamin E supplementation for retinitis pigmentosa. Arch Ophthal 1993;111(6):761–71. [3] Berson EL, Rosner B, Sandberg MA, Weigel-DiFranco C, Moser A, Brockhurst RJ, et al. Further evaluation of docosahexanoic acid in patients with retinitis pigmentosa receiving vitamin A treatment: subgroup analyses. Arch Ophthal 2004;122 (9):1306–14.
⁎ Corresponding author. Via Terni 38 E 13, 00182 Rome, Italy. Tel: +39 333 2731581. E-mail address: [email protected] (S. Salvatore).
0020-7292/$ – see front matter © 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2009.01.027