Cataract surgery

H1235 · May 16

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 · May 17

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

SDianeL · May 17

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.

harshedbuzz · May 17

@H1235

I am sorry you find yourself in this situation.

I would grill the eye surgeon— without looping mom in— about what before and after care look like. Unless he's using a technique that involves a time-release medication inserted at the time of surgery, it would be a hard NO for me. DH's eye drops (5 different ones and different combos and schedules for each eye done 2-weeks apart) were 4x a day for the first 2 weeks. It's a lifestyle for a bit. If she lived with you and was 100% agreeable to you managing the schedule([s]— a different one for each eye for about 6 weeks total) of drops and being policed around eye patches, shields and heavy lifting that could be an option but I still would not recommend.

VD tends to progress in a stair-step fashion, the two procedures have the risk to trigger a significant drop in function and trigger the need for a higher level of care. FWIW, I find those closest to the PWD underestimate the impact of dementia on their LO— something about those rosy-tinted googles we tend to wear.

HB

weareallunique · May 18

Dementia can cause visual distortions - so even with a sharp crystal clear image coming in the brain could distort what lands. If the first operation causes her distress and they can't do the second eye that may cause her a warped image and increase the chance of falling. Can she be trusted to not touch her eyes, comply with the drops during post-op? Not lift the laundry basket?

And if she does have both eyes done , there is a chance she'd need YAG laser capsulotomy down the road- where the eyes capsule -holds the lens- has fogged and needs a laser cut . So it's not a once and done.

"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" No place can really force a resident to do something , AL, like the name, assists but the patient can say yes or no, MC usually has a better staff to patient ratio but unless safety they aren't going to force a behavior.

On mammograms etc. - now that you know her self worth is wrapped up in what Doctors want - don't mention any testing, procedure unless she really needs it. Ask the eye doctor to stop mentioning the operation if you as AHCD holder won't agree. If she's past the age they reco mammograms and she brings it up out of the blue - say modern equipment is so good now her last test was good for another year . Rinse repeat.

H1235 · May 31

Update- we have decided she is going to have the surgery. Both her pcp and the eye doctor seemed to think she would be fine. I opted for the more expensive 3 eye drops in one to make it easier for her Al staff. So it’s just one drop 4 times a day. One of my biggest concerns is the staff administering the drops properly. I plan to label the bottles with instructions (left eye only, they must administer). I knew each eye would be done at a different time and that there would be follow up appointments, but wow. There are 7 appointments and then more for glasses when it’s done. I’m 45 min from mom. Surgery is 45 min from moms( we are in a rural area). Follow ups will be close to mom so that is good. On top of everything else (getting her house cleaned out- hoarder, managing finances and making sure mom has everything she needs) As expected my brother is no help at all. I hope I’m doing the right thing. I’m so overwhelmed!

harshedbuzz · May 31

@H1235

I hope things go well for you and your mom. Let us know how it went if you get the chance.

HB

weareallunique · May 31

I'd have the home send a text after each eye drop is administered. 4 times a day means every shift will be involved and you'll want to be sure none get missed between shift changes since most meds are maintenance and not so time critical as eye post-op.

HB is right "It's a lifestyle for a bit." I used graph paper to fill in the boxes to not miss a drop and a timer - was going cuckoo by the end.

harshedbuzz · May 31

@weareallunique

I made a spread sheet for the 6 weeks and 3 days. I set alarms on my phone, too.

HB

SiberianIris · May 31

My mom had combined cataract and glaucoma surgery at age 93. Long story short, it went well, and I'm glad we did it.

That was 3 years ago, before she had any dementia diagnosis. We thought her memory struggles were just old age. Her struggle understanding and adhering to the post surgery eye drop protocol was a real wake up call.

Thankfully she had already been happily living in a CCRC, so getting extra help with medication management was a godsend.

A few months after that, the CCRC called a meeting with me and my siblings to tell us she had mixed dementia (ALZ and vascular). I'd say she was in early stage 4 at the time.

dayprov · June 1

My 83 year old mother with alzheimers had cataract surgery and it went well. However, as some people here have mentioned, it did indeed take 24/7 observation for about 2 weeks after each eye. We did one eye at a time. I'm in my early 50's and work full time, but took a 4 week leave of absence from work to care for her. And when I say "care", I mean I literally watched her and reminded her constantly not to (a) try to take her eye patch off, (b) try to scratch under her eye patch, and (c) not to bend over to pick something up. Literally hundreds of times a day. It was easy work in the sense that these three things were literally all I had to do (other than put her eye drops in as prescribed), but it takes a lot of commitment. It's impossible for an alzheimers patient to remember doctors instructions, so as long as there's a loved one who is able to follow them around like this (even to the bathroom, shower, bed, etc), the surgery would be worth it. She was much happier being able to see!

Di-loves-Daddy · June 2

https://alzconnected.org/discussion/73060/cataract-surgery

My dad, 78, with mid-stage dementia, lives in assisted living. He had his first eye (cataract) surgery in May and is having his second one tomorrow with the VA. The aftercare was very simple for him. Just wear a patch over the eye for 3 days, 24 hours a day; then at night for a week. They implanted a slow-release medication (I don't know the name), so no drops were required. He did great! The main thing was reminding him not to touch his eye and not to rub, which the eye patch helped with.

Cataract surgery

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