AD and Cataracts - Ophthalmologists Good With Alzheimers?

Lazuza

My LO has cataracts. She is expressing that she wants to have them removed but is having difficulty tolerating the testing required to measure lens depth. The machines attempted (e.g., IOL Master) were unable to obtain the needed readings.

Without throwing any information our way, the assistants then took my LO into a room and tried to insert a plastic cup with a tube and saline into my LO's eye, which is apparently another test to get these readings. It looked like quite uncomfortable and given my LO's dementia, she couldn't tolerate the test. They contacted her surgeon who recommended clamping my LO's eye open with a metal device to perform the testing. This was done several years ago. It left my LO's skin bruised for a week and the testing was still unsuccessful. I asked for a break and mom was rescheduled.

The office is being very unsympathetic about mom's cognitive limitations, so I don't think we are going back there. I asked if there are any alternatives. There has been a lack of responsiveness by the office.

Are there ophthalmologists who are good in dealing with individuals with dementia? (E.g., are geriatric ophthalmologists a thing?) We are outside of Boston if anyone possibly has specific recommendations.

Daisie

I'm having the same challenge. My mom's ophthalmologist's office isn't very sympathetic to either of us and figures I can just follow her all day to make sure she complies with their post-op instructions since I work from home. A friend of mine who's only 40 just had two cataracts removed (I know! Crazy!), and he said the post-op at-home care would be too much for me and my mom, given her stage 6 MD. He said it drove HIM crazy for almost a month!

While her PCP says it would help with balance and depth perception, I don't know if that outweighs the stress of surgery and aftercare. I've also been told that the anesthetic can cause MD symptoms to get worse in the long haul. Another friend of mine said if my mom's vision is good enough at 90 to get around and see the TV and is not concerned about reading (she's not), maybe it's not a good idea to have them removed.

I know this probably doesn't help much, but I understand this dilemma and can sympathize!

harshedbuzz

@Lazuza

If your mom can't tolerate the necessary testing to evaluate, she's not going to be able to cooperate with the extensive pre-and post-op care to say nothing of the actual surgery. These places, even the best ones, operate almost like factories given how low the reimbursement from Medicare is. I doubt you'll find someone specializing in dementia. Given that by the middle stages, much visual processing (which is a brain task rather than eye) is impaired to an increasing degree anyway.

HB

Anonymousjpl123

@Lazuza so frustrating. A lot of docs do not understand the extend to which dementia limits individual tolerance or understand of medical procedures. My two cents? See if anyone local has recommendations, or even check with one of the hospitals with memory care centers. They may have some suggestions or be able to talk to the ophthalmologist.

That said, as others have said, it may not be worth it. My mom’s hearing is shot but after replacing 3 sets of hearing aids I was done. She can still hear enough in close situations to converse. It wasn’t worth the stress.

Lazuza

https://alzconnected.org/discussion/comment/217641#Comment_217641

Yes, this has crossed my mind. However, the surgeon said they would use more than local anesthesia with mom and do just one eye at a time. The latter isn't unusual, I know.

Mom's stage 5 AD, so this has definitely been a slippery slope. I'm here with her almost all the time as I WFH too, so I can help her comply with any post-surgery instructions but getting past this testing just doesn't seem possible.

Thanks for your insights, everyone! We have an appointment coming up at one of the major memory centers in the US and I'll definitely ask about it then. I'll pass along anything I learn that's potentially helpful!

fmb

At age 63 with no dementia, I just had my cataracts removed, and there is no way I would put a loved one in Stage 5 through the procedure. A great deal of cooperation on the part of the patient is required both in the pre-op testing and the post-op follow-up appointments, not to mention the complicated regimen of eyedrops required for four weeks after each eye is done. Would she tolerate the protective hard plastic eye patch that has to be worn at night for at least a week? Would she remember not to rub her eyes? Is she still cognitively able to read the letters on the eye chart to determine the correct prescription? I know my DH would not have been able to do any of that when he was in Stage 5.

Lazuza

Hi everyone,

Mom was seen by the memory center at a major, very respected medical center this week.

The neurologist actually said to, "GET IT DONE!" He recommended contacting the area's major eye center and explaining mom's special needs.

Mom is cognitively able to read letters.

I am taking everyone's advice under consideration. Thank you for sharing your experiences. It's definitely not an easy decision and having information from caregivers has been very important for us.

harshedbuzz

@Lazuza

I imagine the big eye and ear hospital may have someone who can accommodate her.

There was a poster a few years back who had his wife's cataracts done. Her doctor used a different approach to medication in the form of a time release "patch" inserted at the time of the surgery in lieu of drops. You might ask about it.

HB

harshedbuzz

Here's a link to that thread-

Cataract surgery(3) — ALZConnected