Treating cataracts

[GillyW]

My mother's recent diagnosis of cataracts is really challenging us - should we proceed with the operation or not?
She is 78 with late stage Alzheimer's & would need a general anaesthetic, disorientation with a stay in hospital, & how can one stop her rubbing eyes after the operation & doing more damage?
At present the cataracts aren't stopping her mobility but we don't know what impact they are having on her quality of life?
Does anyone have any experience to help us make a decision?

 

[Christin]

Hello Gilly, welcome to Talking Point

This is a very difficult one. I think if I were you I would be guided by the consultants. My FIL did have cataracts removed from both eyes years ago, but the dementia was very early stages then. We were amazed at the difference it made to his sight, and it did improve his quality of life. He was treated as a day patient, and came home the same day. A lot will depend on the understanding that your mother has.

I hope someone will be along soon with better experience for you.

Good luck, and best wishes to you and your mother. x

 

[Katrine]

Thoughts

There would be obvious benefits from the surgery if you can find a way around the post-operative difficulties you have identified and the effect of general anaesthetic on a person with dementia which can increase confusion.

People with dementia lose their ability to see objects in medium- and low-contrast environments, but boosting the contrast of objects improves their ability to move around their homes and to eat. Improving vision can also help them to recognise family members and other people close to them which will make them feel more secure. If your vision is blurry, then your memory may be more faulty than necessary. If you can't perceive something it is hard to remember it.

My MIL had her cataracts done (they generally do one eye at a time but perhaps in this case they plan to do both together). In our case MIL had sufficient understanding not to rub her eye and she was able to apply drops herself. The benefits were great for her as they also fixed her extreme short sight and she stopped wearing the bottle glasses she had needed all her life (she still wears glasses).

To MIL blurred vision definitely increases her confusion. She has to be reminded sometimes to use artificial tears as otherwise she rubs and rubs and gets agitated, as she does with any physical discomfort. It is interesting that when she is having a bad patch with her dementia she also always complains of blurred vision. In her case she has vascular dementia and there must be something going on with blood flow in her brain affecting her ability to process what she sees.

With regard to post-operative care, have you asked the eye hospital about this? Since many elderly people who have cataract surgery have a degree of dementia I would expect them to come across this situation on a regular basis. Perhaps there is some sort of shield contraption or eye patch that could be fixed to prevent fiddling? Hope you get some more practical advice based on experience from other TPers. Very best of luck. Katrine

 

[TedHutchinson]

Cataract and cognitive impairment: a review of the literature
The wording of this 2009 free online paper is very similar to the latest version at BMJ. Cataract and cognitive impairment

Patients with dementia and cognitive impairment may achieve poorer postoperative outcomes and need to be counselled about this before surgery.

As Christin suggests you can only be guided by the consultant and hope for the best but you have to be aware that in advanced dementia it may not make much difference in the long term but may cause a certain amount of distress at the time.

 

[Saffie]

My uderstanding is that a general anaesthetic is not necessary for the cataract operation as stated by original post.(or perhaps there are special circumstances why this might be necessary in this case. )I am due to have mine done soon and know a number of people who have had theirs operated on - all with local anaesthetic. In and out in a couple of hours. You have to be areful not to jerk your head for days afterwards as the new lens could dislodge and of course, refrain from driving for some days but otherwise, I understand it is quite straightforward. I'm hoping so anyway!!!!

 

[bunnies]

I guess the general anasthaetic is needed because your mother might not otherwise do as instructed for the operation. I just wanted to add that I was very worried about the effect of the general anasthaetic on my aunt when she had a masectomy when she was in mid-stage vd, living at home with live in carers. I had read lots of bad things about possible impact on her dementia. In the event I didn't notice any deterioration at all from the operation - she bounced back to where she was within a day. The worst effect is simply having to be in hospital - if you can keep that to a minimum that helps.

 

[GillyW]

Thanks for the views and information, in my mother's case her GP has recommended a general anaesthetic because we know that she wouldn't keep still - she wouldn't remember what was happening, where she was or why!
Our predicament is that the optician clearly thinks it would be the right thing to do (1 eye is more advanced than the other so not sure if it would be 1 or both) however her GP is in 2 minds as her dementia is very advanced & she manages to get around ok thanks to 2 new hips & is settled now in her residential home.
My initial reaction was to go ahead and have it done why wouldn't you and then the conversation with her GP giving the other side is very difficult to decide as we just don't know what we will gain if anything & could just add to her confusion even more. It's possible that she's had cataracts for a while - I'm not sure when she last had her eyes tested as she didn't want to. Aagghhh!!!

 

[Jancis]

My uderstanding is that a general anaesthetic is not necessary for the cataract operation as stated by original post.(or perhaps there are special circumstances why this might be necessary in this case. )I am due to have mine done soon and know a number of people who have had theirs operated on - all with local anaesthetic. In and out in a couple of hours. You have to be areful not to jerk your head for days afterwards as the new lens could dislodge and of course, refrain from driving for some days but otherwise, I understand it is quite straightforward. I'm hoping so anyway!!!!

I have had cataracts removed, one eye with a general anaesthetic (at my request) and for the other I plucked up courage to have a local. Personally speaking, and I don't suffer from dementia, I found the experience under the local stressful. The surgeon was excellent - a kind and lovely man who talked me through everything but the clamping of my eyelid and the noises and lights of the theater were surreal and unsettling and I was extremely glad when it was over. The op only took about 15 minutes but time has no relevance really. It is very important to be absolutely still while the consultant is doing his micro-surgery - someone with dementia might not be able to cope with all of this and so the risk must be high. And this is before considering the after care. Having said all of this, my vision is now brilliantly clear whereas my great grandmother lost her sight at a very early age through the same condition.

 

[helen6205]

Hi Gilly

My Mum is also in the very late stages of dementia, and has a great history of eye problems. Many years ago she had the cataract operation, and obviously technology was nowhere near what it is today. Both retinas detached five times, even before her dementia started. She landed up with tunnel vision, and was always very unsteady on her feet.

Getting to your question, I concur 100% with the advice given by other TP members, go with what the Consultant suggests. Perhaps obtain a few other opinions too, not sure if this is possible in the UK??

To illustrate this point, Mum lost total vision in her one eye (this eye is now totally white)about six months ago. Dad arranged for a consultant to examine Mum very recently in the home, since she is now totally bedridden. His suggestion was to concentrate more on Mum's comfort than anything else. As Mum is now sleeping most of the day, the glasses are more of an irritation to her than anything else. Dad always wanting to do the best for Mum, took his advice.

I realise your situation is very different, but leaving it in a consultants hands would probably be the best option.

 

[GillyW]

Thanks Helen - unfortunately the consultant is in 2 minds as it really isn't a clear decision either way - I am hoping that someone has already made the decision and can help one way or another - as Mum is quite settled and gets around ok I'm not going to make any quick decisions, I just don't know what we are going to gain having it done as there's very little she can actually do now compared to the distress she will definitely go through.

 

[Carolynlott]

Hi Gilly,
Obviously every case is different but I would think very carefully before agreeing to a general anaesthetic for your Mum if it isn't absolutely necessary. My Mum trapped her finger in a door a few months ago and ended up having a general anaesthetic to sort it out. I was warned beforehand that it might have an adverse effect on her. Mum instantly became a different person - aggressive, shouting, hitting herself and anything in reach. So much so that she is now in a nursing home because the home she was in couldn't cope with her any more. Maybe she would have gone through this stage anyway, who knows.
C

 

[GillyW]

Thanks Carolyn, I must say that I'm now thinking it would be best to leave Mum as she is as she is settled and her dementia advanced so I'm really not sure what we will actually achieve. I do hope your Mum settles down again it's all just so horrid!

 

[TedHutchinson]

Thanks Carolyn, I must say that I'm now thinking it would be best to leave Mum as she is as she is settled and her dementia advanced so I'm really not sure what we will actually achieve. I do hope your Mum settles down again it's all just so horrid!

Whatever you/your health professionals decide please don't beat yourself up afterwards whatever the outcome.
The answer to the choice of surgery or not, is uncertain.
But we can only make decisions based on the information we have at the time.
With hindsight we may have made better choices but none of us can see what the future will bring.

It's interesting to see that even
Doctors 'often defy' their own treatment advice

 

[Contrary Mary]

Hello Gilly

Until last summer when Mum went into hospital and was very bad afterwards Mum was seeing an eye specialist having been referred originally in case of problems with her diabetes. At one appointment the doctor we saw asked if I wanted Mum to have a cataract operation. I was very dubious because of Mum's dementia and whether it would be worth all the risks and it was agreed that she should return to the hospital after 6 months.

At the next appointment we saw the consultant. He was totally in agreement that the operation shouldn't be done. Mum lives with me so good eyesight isn't so imperative. Even so, we are not having any problems really.

I think you do need to consider things all round, and some people may well advise the operation without having regard to the problems with dementia. There have been other threads on TP if you do a search and want to read some more opinions.

Whatever you decide I hope all goes well.
Mary
x

 

[GillyW]

Thanks Mary for your message, I am now of the opinion to leave her as she is, I do think that she has had them for some time as it is only recently that she has let anyone close enough to examine her eyes! Mum certainly gets around alright in the CH so we have potentially a lot to lose & no certainty of any gain at the moment. Gilly

 

[TedHutchinson]

For the benefit of other readers who come to this thread at a later date maryw has provided a link to a PDF copy of the latest version of Cataract and cognitive impairment: a review of the literature here.

 

[NettieK]

Thank you Jancis

I have had cataracts removed, one eye with a general anaesthetic (at my request) and for the other I plucked up courage to have a local. Personally speaking, and I don't suffer from dementia, I found the experience under the local stressful. The surgeon was excellent - a kind and lovely man who talked me through everything but the clamping of my eyelid and the noises and lights of the theater were surreal and unsettling and I was extremely glad when it was over. The op only took about 15 minutes but time has no relevance really. It is very important to be absolutely still while the consultant is doing his micro-surgery - someone with dementia might not be able to cope with all of this and so the risk must be high. And this is before considering the after care. Having said all of this, my vision is now brilliantly clear whereas my great grandmother lost her sight at a very early age through the same condition.

On visiting the Forum for the very first time, I was looking for information about cataract ops for those with vascular dementia (my Dad). Feeling very down in the dumps as his only relative trying to care for him, I read your reply with interest but it was the beautiful quote at the end of it which reduced me to tears. My life feels like it's passing me by at the moment and I truly hope the words in your lovely quotation are true. Thank you so much.

 

[Pheath]

My mother's recent diagnosis of cataracts is really challenging us - should we proceed with the operation or not?
She is 78 with late stage Alzheimer's & would need a general anaesthetic, disorientation with a stay in hospital, & how can one stop her rubbing eyes after the operation & doing more damage?
At present the cataracts aren't stopping her mobility but we don't know what impact they are having on her quality of life?
Does anyone have any experience to help us make a decision?

My dad is 79 and also late stage dementia with a diagnosis of cataracts of 50% in both eyes however when he was taken for an appt screamed and shouted and wouldn't let the consultant examine him or get anywhere near his eyes. They concluded that as long as he wasn't banging into obstacles and is passed reading anything it was better just to leave him untreated. We'd heard there was quite a risk of giving someone with dementia a general anaesthetic so it just isn't viable for us to go ahead. We regret not getting them done much earlier as it's such a simple and minor operation but have accepted that we can't do anything about it now so will just have to hope they stay stable. Apparently you never go blind with them.

 

[Farmergirl]

Mum has been diagnosed with a cataract in her left eye only this Saturday, so Ive been reading this thread with interest. We are awaiting seeing the GP next week with reference to this. The optician stated that although normal practice is a full anaesthetic, she didnt knowif they would do this with reference to mums large amount of medication.
The other choice is a local anaesthetic,but I doubt if mum would be able to sit still or manage afterwards.
Im sure the gP will refer her to a consultant and I will await his decision.

 

[Oystie]

My mum who has moderate dementia had her first cataract op on Saturday under local anaesthetic. She became very distressed during the op but (a good thiing about dementia) couldn't remembere anything about it afterwards and was telling people it was nothing! Her vision is much improved in that eye and she hasn't had any soreness or redness. The consultant advised that when they do the 2nd eye they would sedate her - which I think is maybe a halfway house between local and general anaesthetic? It seems to have made mum a bit sharper so was worth doing.