Glaucoma and the Pill – Should I Be Worried?

Several national newspapers printed another 'health-scare' story recently. It went along the lines of "if you take the contraceptive pill for more than three years you double your risk of sight-threatening glaucoma".

My normal response is to put my head in my hands, weep quietly for five minutes, then gear myself up for the barrage of questions from worried patients.

I am not quite sure what newspapers hope to achieve by publishing these initial findings as "facts" but it certainly keeps me on my toes! As a Community Optometrist I find myself the local trusted expert on all things ocular so, as soon as a story like this hits the headlines, I can guarantee that I will receive calls from worried patients wondering what they should do.

My basic advice? Ladies, keep taking the tablets!

Various Health organisations, including Moorfields Eye Hospital, The International Glaucoma Association, the Medicines and Healthcare products Regulatory Authority (MHRA) and my professional body, The College of Optometrists, have all issued statements which you can read at the end of this article.

The basic gist of all the statements is:

• The research has not yet been subjected to appropriate scientific peer review and has yet to be published.
• The link that they have found is, so far, purely statistical.
  The phrase "Lies, damned lies and statistics" comes to mind but then I am a natural cynic (attributed variously to Benjamin Disraeli, Mark Twain, Henry Labouchere and others).
• There is not sufficient evidence to show that we should start routinely screening all women on the pill for glaucoma.
• The current recognised risk factors for glaucoma include age, family history of glaucoma, diabetes, short sightedness, ocular hypertension and certain ethnic origins.

My more detailed advice is:

• Ladies, if you are taking the contraceptive pill there is undoubtedly a very a good reason for you being on it, so don't stop taking it. If you are really worried, talk to your GP about alternative forms of contraception.
• Everybody should have a regular full eye examination at least every two years. It doesn't matter if you think you have perfect sight or already wear spectacles, an eye examination checks the health of your eyes as well as your vision.
• Optometrists are highly trained healthcare practitioners who specialise in eyes, and we know a thing or two about spotting glaucoma. A full eye examination will include enough checks to make sure that, if you do develop glaucoma, it is detected early and can be treated.
• I am not denying that glaucoma is a nasty disease – any condition that has earned the nickname "the sneak thief of sight" is not going to be nice - but it is a slow progressive disease that, if detected early, can be managed with medication or sometimes surgery. For as much information as you could possibly want about glaucoma visit the International Glaucoma Association website.

If you have been to Sarah Gibson Optometrist in the past 2 ½ years you will know that we have some advanced screening technology available to screen for Glaucoma and Macular Degeneration. Our OCT scanner is a bit like a CT scan for your eyes – it gets right down to the layers of nerves at the back of the eye and gives us an unprecedented view of what is happening below the surface. If you would like to know more about the OCT have a look at this page on our website or pop in to the practice for a leaflet.

We can also check your peripheral vision, the pressure in your eyes and the health of the back of your eye using more traditional methods as well as the advanced scans and photographs.

I will leave you with this thought...

Which is worse – a significant risk of unplanned pregnancy or a theoretical risk of developing an eye disease that can be managed?

Ladies... keep taking that pill!

For those of you who want to hear from the top experts, here are the quotes I promised you:

A consultant for the Glaucoma Team at Moorfields Eye Hospital, Richard Wormald, warned that the announcement had the potential to "cause a lot of alarm", adding "there's actually no plausible, patho-physiological mechanism whereby oral contraceptives would cause glaucoma."

Pointing to a lack of previous scientific research on a link and the absence of peer review, Mr Wormald said that it could be viewed as a "chance finding" and that the evidence was "potentially, seriously flawed". He added: "It certainly doesn't mean you should start screening all women who have been on oral contraceptives."

Chief executive of the International Glaucoma Association, Russell Young, said: "It's an interesting piece of research, but we simply don't have sufficient details to validate the study and to come to any valid conclusions on it.

"Our recommendation is that any woman who is currently using the contraceptive pill and eye drops to treat their glaucoma, should not stop any medication until they've had a discussion with their ophthalmologist."

The College of Optometrists said: "While the College finds [the results] interesting, we believe that more research is needed in this area."

The college statement also points to the position of the Medicines and Healthcare products Regulatory Authority (MHRA), which disputes the findings and highlights that a link with glaucoma has not been confirmed.

Comments

Login to comment!