Cataracts & Glaucoma

calmmorn

Hi everyone,

My mother is 84 years old in stage 5/6 Alzheimer’s. Her eye doctor says she has cataracts and glaucoma in both eyes, but couldn’t give us a sense of how quickly the conditions could progress. I expressed my concerns about whether my mother could handle the surgical procedures for both conditions given her dementia. Her eye doctor suggested we start with eye drops for the glaucoma but thought we should consider surgery for the cataracts.

I have started my mom on the latanoprost eye drops for the glaucoma. We have a follow up appointment in a few weeks to see if they are doing anything.

I was wondering if there are any folks here who have made this decision for their PWD and could share their experiences. My mother has had very good vision all her life, but there has been noticeable decline over the past several months. Other than the dementia, my mother is still very healthy physically.

I think she could handle the surgery itself (no general anesthesia, 20 mins lying down), because I take her to the dentist every three months (not easy but still somewhat doable). But the post op process is the much bigger question mark (ie how to keep her from touching her eyes for 24 hours a day for weeks). She would not be able to remember that she had the surgery so I think she would be confused by any kind of protective eyewear.

As her primary caregiver, I have accepted that my main focus now is to just try and give her the best quality of life possible. So no more unnecessary procedures/trauma. But I have to admit, this one has thrown me for a loop because it seems like the benefit may be worthwhile.

Sorry for the long post. I would greatly appreciate any experiences that people can share.

harshedbuzz

Cataract surgery(2) — ALZConnected

Cataract surgery(3) — ALZConnected

Update on cataract surgery — ALZConnected

Calmmorn--

This is a topic we chewed on extensively last winter with a regular poster on the spouses board. There's a lot of good insight there.

I would start with drops for glaucoma. Absolutely. That may give you some sense of how she'll do with you doing eye care going forward.

That said, and I am likely repeating myself, I would be reluctant to OK cataract surgery in stage 6ish personally. DH (no dementia) did the old school drops protocol and eye shield and it was something that required compliance and cooperation. Plus there's a concern if she had a complication, like a detached retina, would she be able to report it accurately and in time to reverse the damage. My dad had a detached retina in early dementia and did not-- he lost vision in one eye.

HB

Emily 123

Hi,

As you note, I think the instructions to not touch her eyes after the surgery would be impossible for her to follow. The eyedrops sound like a reasonable option. Maybe she's got some underlying dementia related field of vision loss going on too. I've noticed this in my own mom lately who's in stage 5.

When providers recommend the treatment options for a specific condition there's usually a standard treatment that works best for an 'average' (compliant) patient. Unfortunately, dementia and the challenges it presents are generally not something that are taken into account by the providers when making procedural recommendations, unless they have some insight into the post-discharge caregiving demands of a person with dementia. It leaves a lot of the gatekeeping up to the caregiver. You did a good job asking about the post discharge care requirements.

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calmmorn

Harshedbuzz, Emily and Victoria, thank you so much for your responses.

Harshedbuzz- thank you for the links. There is so much helpful information in there. And I hadn’t even thought about possible complications from the surgery itself. It would be so stressful. That is definitely another point in the “no” column. I am so sorry about your father’s vision loss. That must have made things harder for all of you.

Emily123- yes, you are absolutely right about having to constantly be the gatekeeper for our PWDs. It is exhausting. And yes, I was also wondering whether some of the vision loss was dementia related. The eye doc didn’t mention anything about that. I am sorry that your mother is also experiencing vision loss. I am right there with you.

Victoria2020- my main concern in taking her to the eye doc was her long distance vision. My mother is still very active/mobile. She hates being at home, so we are out and about pretty much everyday. She loves reading every road sign when we are in the car. Lately, she has been asking me more and more to read certain signs for her. It makes her anxious when she can’t read the signs. But you are right. Her world will continue to get smaller and it will be her near vision that will be more important. And I didn’t know that the surgery could make it worse. Another con.

I am going to let the eye doctor know that we will be passing on the surgery. As you all noted, there are just too many possible downsides.

Thank you all again for your feedback and insights. I am so grateful that you are all here.

SDianeL

I just read about cataracts and it says they progress over months or years except those in younger people can grow more quickly. If they can treat the glaucoma maybe that will preserve her eyesight. Wonder if her not being able to read road signs is from the Alzheimer's?