Cataract surgery

H1235

Mom is probably to the end of stage 4. She was diagnosed with vascular dementia 2 years ago. I was told average life expectancy is 5 years. I know that’s just a rough number. She has diabetes with edema in her legs. I don’t think she could follow a storyline to read a book. She is able to choose her meals off the menu at Al on her own. Unlike many here her memory is not too bad. She struggles with executive functioning, anosognosia, short attention span, depression and anger (although this is being treated and is stable for now). The eye doctor said the cataracts have been slowly getting worse over the last few years and he recommends the cataract surgery before her dementia progresses any more. Without the surgery she would need new glasses, but would still be able to see. I’m not real impressed with the care she is receiving at Al. I’m working on that. If she refuses to do something staff just says ok. I think mom would be able and willing to follow the follow up procedures. But she can be very stubborn and independent! She insists on making her own bed and brings her heavy laundry basket out of her room and sets it by the door on laundry day (which she does not need to do). I think she would stop doing this, but I just don’t know. I’m also a bit concerned about the actual procedure. She does fine sitting for a teeth cleaning, but obviously that is different. I think I’m going to patient portal a message to her pcp and get her input. She has been told by the eye dr that he recommends the surgery. I think if we don’t do it she will probably be down and depressed, thinking she’s not going to live long enough to bother with it. I told her I had a mammogram a few weeks ago and she was upset that doctors didn’t even care enough to think she should be continue to have them. I could really use some input from any of you that have faced this decision.

jen ht

Hi H1235,

Mainly writing here in solidarity with you. I have not faced this exact situation, but maybe a bit of a similarity.

Dad has developed a hernia. The idea from his NP at his MC was to refer to a general surgeon with the idea that it's an "easy" fix. He is not having pain with it currently. More like an awareness that it's "there".

The neurologist suggested against the procedure in this case for my dad and the surgeon agreed even prior to the consult appt. Surgeon reviewed the ultrasound and knew of dad's Alz diagnosis and of the the neuro recommendation and so canceled the intake appt.

The concern was with the the meds for the procedure and possible delirium. The idea is that if pain develops we reschedule intake and reassess at that time. For now, for this case… it's more of an "elective". I'm not sure that would apply to your situation, though.

I know the procedure you are talking about is very different. Just thought I would offer this in solidarity as an initial reply. I hope other will weigh in.

With you in spirit,

~jht

ARIL

I have worked out a general plan with my LO’s PCP to guide us in making medical decisions (short of end-of-life care, which is already spelled out in legal documents). Unless there are major mitigating circumstances, we will not to do surgeries that would require anesthetic for the reasons the previous poster mentions (delirium, etc.). For more minor things that do not require general anesthetic, we ask cost/benefit questions about quality of life. Would the procedure do something good that would outweigh the burden of going through it?

For the situation you describe, I think you are doing right to get advice from the PCP. In general, I’d consider going ahead with the cataract surgery if your mother (at stage 4) has said she wants it, the doctors agree it would improve her vision, and it’s manageable to get done before the dementia progresses further. On the other hand, if the follow-up care is not going to go well and might produce worse problems, there is no harm in going the new-glasses route. At later stages (my LO is at late stage 6), I’d give elective surgery a miss.

You are being careful and thoughtful. After gathering information and advice from the PCP, you will make a choice, and it will be the right one. Either way.

SDianeL

I would ask about the post surgical care. She may require 24/7 care for that. She may not remember the instructions or be able to follow them precisely. I found this: “After cataract surgery, it's crucial to follow your surgeon's instructions closely for optimal healing and vision restoration. Dos: Use prescribed eye drops as directed, rest, wear protective shields or glasses, and attend follow-up appointments. Don'ts: Rub or press on the eye, get soap or water directly in the eye, engage in strenuous activities.” Based on this I would opt for glasses not surgery.