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Cataract Removal Experiences?
My Dad has cataracts really bad....and needs to have them removed...I was told by the eye Dr. he was scheduled to have them removed 2 years ago but cancelled.
I was wondering how many peoples loved ones have had the cataract procedure after being diagnosed with ALZ or demetia?
I was reading about the types of anethesia...as I know I don't want my Dad on any of that because it WILL worsen his symptoms...it is proven to worsen symptoms in patients with dementia for up to 10 DAYS.
I remember hearing the Dr telling my Dad today that the anesethestic would be topical...so that means he will have a loc region numbing...which is highly suggested by specialists in the area of dementia and ALZ for any dementia patient to have localized "anesthesia"...because how much effect it can have on someone with dementia.
Another study revealed that patients with dementia that have cataract surgery, recover very quickly with local numbing..and even signs and symptoms that were present prior to the Cataract surgery may substansually subside because being able to see...literally changes their whold prespective in life....from colors..to seeing clear...not fearing losing his eyesight but the surgery either eliminates or reduces the need for any glasses (farsighted)...does nothing for nearsightness.
I wanted to ask..since my Dad is having the Surgery in June..unter a local...I'm going to ask his Dr. what he thinks would be the best medication as a SEDATIV for this procedur?
I know his Dr. will say Lorazepam......Lorazepam is somthing I have in the house and it works wonderful....
I'm glad I'm figureing this out before his May 21 appointment with PCP..where I have a couple medication concerns for my Dad...
I would like to know if your loved one was sedated for any procedure? I'm going to for SURE ask my Dads Dr...for what he thinks is best.....
But I wonder if anyone else has ever been in similar situation with wanting to keep a loved one comfortable during a procedure...
But, not knowing what to do because of the unpredictablity of this illness is very, very hard.
Echoing day2night2 here...there is more than just surgery and sedation, ther are drops 4 times per day for 2 weeks. Another concern is agitation during the surgery. Both my mom and I have had this surgery. I'm not demented (in the sense of this site, at least) and the surgery was easy plus wow, the results! But Mom...the first time anyone used the word "sun downing" to me was right after the surgery. I didn't think she had ALZ at the time, so chalked up her reaction to being part of her schizophrenia. (Wish I had known then what I know now...so many signs.) We did the surgeries in the morning, normally her best time. Each of us had mild anesthesia, not sure what kind. Here is mom's experience:
I sense that you want to manage the result by managing the type of sedation. That's understandable, but unless you are a medical professional, let the doctors confer together to come up with a plan. Make sure that the Dr managing the dementia is communicating directly with the ophthalmologist.
If your Dad still enjoys reading and lots of activities where sight is the primary sense used, it might be worth it. If not, it might not. Cataract surgery will not slow disease progression.
My Dad has cataracts really bad....and needs to have them removed...I was told by the eye Dr. he was scheduled to have them removed 2 years ago but cancelled.Why was the procedure canceled 2 years ago?
I was wondering how many peoples loved ones have had the cataract procedure after being diagnosed with ALZ or demetia?I have been through this with my DH and a couple of friends who do not have dementia. While it is a simple day procedure for most, it requires significant care that would be beyond the abilities of most people who are impaired enough to be diagnosed with more than MCI. The initial evaluation for DH took about 90 minutes with the surgeon and his staff. He was asked to do certain tasks and to report how things looked and/or felt in great detail. The procedure itself is reported to be as a little "disturbing"; will your dad be OK with strangers prompting him and keeping him calm. Day of, the docs near me tend to do this assembly line style. Procedures are Tuesdays at the local hospital (for those who are sicker/older) and Thursdays at the freestanding surgical center. Appointment scheduling is random, so you might want to ask for the first slot in order that your dad gets in before it gets more chaotic. Then there are the drops. They start several days ahead of time- DH had 3 different medications; 4 doses of 2 kinds and 2 doses of the other ahead of surgery. Day of the surgery you don't have to do anything except keep the eye protected. Then you start with a reducing protocol of drops over the next 4 weeks. Keeping track of which drop when was a little challenging; DH's were a little different because one eye was much worse and needed an additional prescription. Someone will need to track these for him and instill them. The tips need to be kept clean. DH dropped one and we needed to replace it. It was the one with the $80 co-pay and no coupon. Be sure to ask the surgeon for coupons for the required drops which can lower your OOP costs. DH's doctor had him in safety glasses for 2 weeks after each eye and a protective shell at night for a week for each. DH was a chemist in his professional life, so he's great with safety glasses, the shell was difficult for him to tape on and sleep with. He was happy to be rid of it.
I remember hearing the Dr telling my Dad today that the anesethestic would be topical...so that means he will have a loc region numbing...which is highly suggested by specialists in the area of dementia and ALZ for any dementia patient to have localized "anesthesia"...because how much effect it can have on someone with dementia.You'll want to speak with the anesthesiologist directly. The surgeon may have an idea of what is used, but the anesthesiologist or nurse-anesthetist will be making the final call. DH had the numbing drops and Versed IV. My friend did as well. My BIL had general anesthesia because he tends to be an anxious patient (as many physicians are) and his surgeon wanted him out cold.
Another study revealed that patients with dementia that have cataract surgery, recover very quickly with local numbing..and even signs and symptoms that were present prior to the Cataract surgery may substansually subside because being able to see...literally changes their whold prespective in life....from colors..to seeing clear...not fearing losing his eyesight but the surgery either eliminates or reduces the need for any glasses (farsighted)...does nothing for nearsightness.You can get custom lenses to correct vision. Most people get the Medicare standard lens that corrects distance vision (myopia) and use readers. My BIL got a custom bifocal lenses. DH got the basic lenses and wears bifocals to correct a mild astigmatism and see close up. Did the study look at what stage of dementia their participants had? I could see where those with mild or early moderate stages would be helped, but not necessarily those who were already having vision issues related to brain changes.
I know his Dr. will say Lorazepam......Lorazepam is somthing I have in the house and it works wonderful....You do not want to give your dad any medication you have on hand ahead of time. The person doing the anesthesia should manage his meds. They may have some guidelines around whether he should take his usual prescriptions that day or even discontinue certain meds ahead of the procedures. He'll likely get drops to numb the eye and sedation of some kind. DH's got really mild sedation; we were out in about 90 minutes and went to breakfast both times. He was less out of it that he's been after some dental work he's had done over the years. DH does recall the procedure; he and the surgeon had a discussion about the history of cataract surgery during the left eye and the composition of plastic in the lenses during the right which DH recalled.
But, not knowing what to do because of the unpredictablity of this illness is very, very hard.TBH, I would be consulting with the neurologist on this as well. You want to be certain he is in a stage where the benefit of the procedure is worth the risks and the before and aftercare that comes with. Who will be managing the drops? Unless your mom can be relied on, you will need to be there 4 times a day for a little over 2 weeks for each eye, then twice a day for probably another 2 weeks. He'll need to cooperate with eye protection and not touching his eyes which may feel irritated at first. Good luck.HB
While the procedure itself is quick and simple with a cooperative patient, the after care is an issue as MissCory points out. There are drops that must be put in, and it is important that the patient not rub at the eye or bend over as it can disrupt the surgical site. Had we proceeded with the surgery, I would have hired extra personnel to sit with her 24 hours a day.
It sounds as though your dad has a lot of time to reap the benefits of this procedure, and he does enjoy some social activities with you. Just be aware that ophthalmologists and eye surgeons are not dementia doctors and do not necessarily take all of the factors into consideration that we do as advocates for our LOs. Clear communication with the team is essential, and you will have to have an after care plan; it doesn't seem likely that your mom will ensure that the drops are in and the precautions taken.
My SIL had cataract surgery herself; she said it made a huge difference for night-time driving; this is not much of a concern for our LOs.
I'm understanding from these replies that I am going to HAVE to recruit my Mother and possibly my sister upstairs in some form to make sure pre surgery and post surgery he is using the drops correctly.
With 3 of us being able to ensure he is using the drops...he should be ok.
I'm hoping and giving my Mother the benefit of the doubt that she will be helpful during this time.
My Dad yesterday in the appointment was very good...it was like he was a normal patient...asking questions after we watched the informational video on both the traditional and laser surgeries...He had appropriate questions for the Dr...so it seemed like he did not have dementia at all.
But, the first medication I listed on the medication list for the Dr to review was Aricept...and the reason documented for the Aricept is dementia...but I did not talk about this in the office...as I plan to talk to my Dads Dr about all this and either have him or myself call the surgical center to make sure they understand exactly what they are dealing with and how they should proceed with the sedation.
I said we have the Lorazepam at home because this is something his body is used to and I feel like he will have less complications if Lorazepam is STUCK to for his sedation and I am wondering if the Dr will tell my Dad to take a little bit more that morning...and of course we would let the surgical team know ahead of time as well what he has taken....Lorazepam was on his list of medications and they did tell him to take all his medications as usual.
My most concerning thing in your reply is this "patch" no one mentioned a patch was going to be applied to his eye....I'm wondering why the patch? The extra protection? Or to keep it from the light? I wonder if sunglasses while awake would be just as good...I have to find out about this "patch".
So when they called him to schedule the cataract surgery that the eye dr recommended at the time...he refused the appointment.
When we were in the eye Dr. this time after he failed his eye exam for driving...she asked him why he didn't go to the scheduled appointment....He said no one called him to set up the appointment...and he really believes this.
My Mother told me two years ago that he canceled the appointment and she was mad at him for that at the time...so "I" remember that he canceled it....but I just go along with him when he says no one called him to go to that appointment.
Missy, the "patch" is the same thing someone else called a "shield" (which is a better term). It is a hard plastic eyepatch that has to be taped over the eye after surgery and replaced each time after putting in drops. It protects the patient from scratching, rubbing, or irritating the eye, especially at night during sleep. It has to stay on for about 24 hours after surgery, except when putting in all the drops. I was advised to wear mine while sleeping for about 2 weeks, I think (it's been a while - might have only been 1 week.)
I get that you are going for the joy of sight. My mom was still living independently and walking herself to the store, so I'm sure being able to see helped keep her safer, and I think for a short time it helped her be more confident in walking - she seemed more upright, not always looking down at the ground. She frequently commented how nice it was to see. But even then, when I didn't know all that was wrong, I found myself reminding her that she didn't need glasses anymore. She put them on out of habit. Looking back, I see she couldn't rationalize that her vision was 20-20 now.
So yes, the surgery improved her vision, her appreciation of sight, even her joy, but not her memory, at all, not even a tiny bit.
I'm not saying don't have it, not recommending pro or con - there are lots of both. Your family will have to get on the same page about who will help him consistently with the aftercare, so I'm glad to hear you think that can be managed. Perhaps your dad is doing what you remind him of after phone calls. My mom could not be counted on to follow through, sometimes out of "I don't have to do what people tell me, I'm an adult, dammit!" (even though she didn't say this to me out loud, except the day after the surgery when it was most important.) But sometimes she didn't follow through on things because she probably already forgot after I hung up. The only way to know for sure is to be there doing it, or have someone you trust there doing it.
What HB said about having the neurologist consult with the surgeon, and if possible, the anesthesiologist is great advice, especially if your dad is seeming like a normal patient at the eye doctor. So many balls to juggle when we help our LO's successfully get through something like this! Good luck to you and your dad.
I get that you are going for the joy of site. My mom was still living independently and walking herself to the store, so I'm sure being able to see helped keep her safer, and I think for a short time it helped her be more confident in walking - she seemed more upright, not always looking down at the ground. She frequently commented how nice it was to see. But even then, when I didn't know all that was wrong, I found myself reminding her that she didn't need glasses anymore. She put them on out of habit. Looking back, I see she couldn't rationalize that her vision was 20-20 now.
If I have to do this with the drops...I feel he can follow directions...If he struggles I will go over there and enlist those 2 (my Mom and my sister).
Great idea to observe him with saline drops ahead of time! I will do that....And to differentiate between the drops I am going to mark the bottles with the numbers 1, 2, 3 in black marker...I did something similar to this for my boyfriends Mom..not for cataracts but for something else...cause your right they don't understand the bottles at all...
I do have all the instructions for the eye care prior and post..and his orders are 3 days before the 3x a day (3 bottles) and the same for 3 days after...not a week....3 days before, 3 days after...and the day of...he has the one bottle to put in every 15 minutes for 2 hours prior to the surgery. I thought I was going to puke when I found out all this was involved because OF my fear of #1 is my Mother going to help? and #2...Now I have to deal with her when I am avoiding her at all costs for my own mental health.
Of course this comes down to self survival for me...this is all about am I going to be able to manage to get him thru this...cause it appears I am all he has....but I hope I am wrong and that my sister and Mom will help out...
I "know" my sister will do whatever she can...she will...she just has a sick child to care for and a full time job and she also can't be in the same room with my Mother without a bunch of drama.
I'm not really worried thou about my sister not cooperating..she has already assured me that if anything comes up with "Dad" that she can help with to let her know...
I completely feel like my Mother should manage this....but it is far away at the moment..June 11th....So I have time to talk to my Dads Dr...and my therapist...and you guys....to prepare for talking to my Mom....and to have this all figured out by the time the countdown starts for the procedure.
I would be worried about a couple things besides just the drops. One is the bending over is not allowed post surgery, it causes pressure and strain on the eye and can damage the eye. This is a big problem because we know how long Alz parents remember things, sometimes 2 minutes before we are repeating ourselves again "Don't do that". Who is going to be with him 24 hours a day making sure he doesn't bend over at the waist, look down at the table, look down at his feet when walking?
Who is going to make sure he doesn't rub or itch his eyes? Who will be there if he has to have the patch on for the first day for 24 hours? Maybe you could take him to your house for one day? And then there's the being in a car issue. No bumps in the road after surgery coming home, no potholes, no slamming on the brakes. Riding in a car is something to be avoided for days. The ride home should be bump-free.
Sorry, don't want to add more stress thinking about this, but these are all concerns I see. Hopefully your mother will step up and do her part. But when he's awake and she is sleeping, there will be nobody to watch him and remind him Do not look down, do not rub your eye, etc.
I do have all the instructions for the eye care prior and post..and his orders are 3 days before the 3x a day (3 bottles) and the same for 3 days after...not a week....3 days before, 3 days after...and the day of...he has the one bottle to put in every 15 minutes for 2 hours prior to the surgery. Just an FYI- DH's surgeon gave the prescriptions and instructions for the pre-op drops and the days immediately after. Then at the post-surgical visit, he laid out a new schedule for the next 2 weeks until the optometrist took over. The optometrist prescribed an additional 2 weeks of drops 2 weeks after he had the surgery. I asked the surgeon about this and he said it was to avoid confusing and overwhelming patients. Plus DH needed a different medication because one of his eyes needed more intensive work than most people have so I had to run out for an additional medication. I thought I was going to puke when I found out all this was involved because OF my fear of #1 is my Mother going to help? and #2...Now I have to deal with her when I am avoiding her at all costs for my own mental health.I would make sure you understand the bigger care picture. We went in knowing only about the first of four weeks worth of care.
I completely feel like my Mother should manage this....but it is far away at the moment..June 11th....So I have time to talk to my Dads Dr...and my therapist...and you guys....to prepare for talking to my Mom....and to have this all figured out by the time the countdown starts for the procedure.You can ultimately control your own behavior- not your mom's. If you can't trust her, you can do all of the care yourself, hire someone to do the appropriate care or pass on the procedure.
I had both eyes done...a year apart since the first was such a big improvement. Drops before, appointment that afternoon not next day...patch at night for 3 nights, and drops for a period of days. Followup appointment in a week and then in a month.
With a local I would worry about movement during the surgery! I think I was in some kind of restraints. I do not think I would do well knowing what was going on.
Our cataract story goes like this
Early November - surgery on right eye. LO spoke fluent Spanish during procedure. She studied Spanish in college. We were just starting to learn the extent of the dementia.
December - LO spent month with relatives. Not a lot of oversight with meds, drops or personal care
Late December - Came home with eye infection. Preservatives in antibiotic drops massively inflamed cornea. Inability to completely close eye (delayed effect of previous eyelid surgery) caused dry patch on surface. (We are still treating this condition) we've had to eliminate any eye product with preservatives.
Early January - fell and broke hip, had UTI. Hospital increased antibiotic drops and nobody put moisture drops in eye or patched her eye closed at night. Dry patch got worse. Not able to get to eye dr.
We might have this under control. However they dialated LO's eye yesterday. Aweful! I will argue hard against that again as it really hinders her ability to function.
So while the surgery was to lower fall risk, we had a fall and are still dealing with eye issues 6 months later. I think we may be getting out of the forest. It was a long complicated thing. However her sight was 20/40 yesterday. I'll take it.
Oh, my. Here's my experience for both me and LO. (LO had AD at the time of the surgery).
LO had to have drops instilled presurgery, I did not. This is the surgeons' preference.
Nothing by mouth after midnight. (The surgical team was ready to cancel my surgery because I was chewing gum to relieve dryness. Oops) Thus, no pills, tablets, capsules, etc.
Schedule the earliest surgery time possible. Nothing quite like having an afternoon surgery when you've had nothing to eat or drink since midnight. See a pattern here?
I've never heard of general anesthesia for cataract surgery. A sedative administered via IV will relax your father. This is why anesthesiologists are paid the big bucks.
Cataract surgery is important. If the cataract becomes too dense, the docs can't see what the hell is going on behind the cataract. There are age related ocular diseases, such as macular degeneraton, that cannot be seen through a dense cataract.
Questions regarding the surgery and what to expect need to be addressed by the surgeon, NOT the PCP. Each surgeon has their own preferences regarding the procedure and of course, will be the ones calling the shots. Around here, the PCP will make sure the preop exam, as ordered by the surgeon, is completed.
I’m following this post and replies closely as my mother’s optometrist is recommending cataract surgery. I have serious misgivings about it:
1) She was made aware of the issue well over ten years ago (when still competent) and chose not to pursue surgery all that time.
2) When in the optometrist’s exam room, she readily agrees to scheduling the procedure, but when I broach the subject again as the day goes on, her “yes” turns into “maybe” which turns into a definite “NO!”
3) She can’t keep her hands away from any injury. When she had shingles, she ripped her skin apart. When she had a bruise on her arm, she kept at it until it was an open sore then kept picking the scab apart so often it couldn’t heal. If she has the surgery, it won’t matter how many reminders she’d get, her hands WILL go straight for that eye shield and won’t leave it alone.
4) Having the surgery won’t result in any physical pain — just the continued diminishment of sight — a shame but not physically painful.
Am I right in thinking this surgery isn’t a good idea for her?
I’ll throw my two cents in. I have gone through this with myself, husband and mother.
One may be allowed to take their usual morning meds with a sip of water. Depends on anesthesiologist and what the meds are.
IV sedation, like Versed, may be used to relax person. It will be light, but sufficient. See next paragraph. It may also block any memory of the actual procedure. It’s a handy and desired side effect. The eye drops given at the hospital do a great job of numbing the eye. (There are many doses of different drops given in the OR holding area about every five minutes.)
General anesthesia is rare for cataract surgery. The doctor wants the patient awake since there is a point in the surgery where directions are given and patient cooperation is needed. Nor do they want you to dose off and startle awake.
The patch is not a patch at all. It is a plastic shield with multiple perforations for air and vision. It does not obscure vision. It is taped to the face and worn until next morning, then at night for a few days. The patient must leave the tape and shield on to prevent incidental rubbing of the eye. My mother had the surgery before her Alzheimer’s was advanced. Now at stage 5-6, she is a “face picker” and probably would not tolerate something on her face. (She had a facial skin cancer removed and had pulled the pressure dressing and skin graft off by nightfall ...return trip to doctor.)
The eye may feel a little itchy for day or so. The eye drops help with this sensation or any pain. There are also steroid drops which prevent scar formation the first few weeks. Scar formation is common even if drops are done correctly. Both my mom and husband had to have a small scar removed on one eye at six months in the office with laser. The other drops are to prevent infection.
All three of us saw immediate improvement in our far vision. Husband no longer needs glasses to drive. It is a great payback for a very quick procedure. If your father has the surgery, you will find that you are hardly comfortable in the waiting room chair before you are told that you can come back to the postop room. I waited for my husband for NINE minutes! It is an assembly line of sorts for the doctor. He did 16 on my day.... another reason to get there early to be at the head of the line!
I hope we have helped with your decision. You see that different people have different experiences. The experience for someone who has dementia adds another level of needs, depending greatly on the person. It will definitely be stressful for you all. Something as simple as eye drops become a big deal. My father undergoes this operation next month. We will have to “double up” with caretakers for him, since Mom cannot be left alone when he is at the hospital.
I will add another perspective. My mom is legally blind from end-stage glaucoma and only sees shapes and shadows. Because she doesn’t see well, she doesn’t have any of the visual cues that would have helped her recognize objects and reinforce memory (ie, if you can’t see it, it’s harder to remember)
I can’t leave a list for her, or a calendar. If she puts something down in the kitchen, walks away and forgets about it, she can’t find it later, and that can get her agitated.
Visual input is so very important, I would take all preparative steps and get the logistics set up for day before, day of, and aftercare so he can have the procedure with as few glitches as possible
Just an FYI- DH's surgeon gave the prescriptions and instructions for the pre-op drops and the days immediately after. Then at the post-surgical visit, he laid out a new schedule for the next 2 weeks until the optometrist took over. The optometrist prescribed an additional 2 weeks of drops 2 weeks after he had the surgery. I asked the surgeon about this and he said it was to avoid confusing and overwhelming patients. Plus DH needed a different medication because one of his eyes needed more intensive work than most people have so I had to run out for an additional medication.
I thought I was going to puke when I found out all this was involved because OF my fear of #1 is my Mother going to help? and #2...Now I have to deal with her when I am avoiding her at all costs for my own mental health.I would make sure you understand the bigger care picture. We went in knowing only about the first of four weeks worth of care.
Your eye Drs office sounded like it was in the middle of a shuffle while your Husband was going thru his surgeries...
This office we go to is very efficient with their process...the top in our State...and we do already have the pre drops the 3 bottles for the 3 days before and the one bottle for the day of surgery. We picked up the drops today and my father insisted that he has to put them in today....OMG...lol
We know that we are getting more prescriptions the day after the first eye is done and then the 2nd eye will be done a week later....they told me they could do the 2nd eye a DAY later, a week later or 2 weeks later they said they leave that up to the patient after the first eye is completed......and I said if all goes well we would like the 2nd one done the following week and the Surgeon agreed.
You gave me a good idea to look for a backup caregiver for the day of the surgery..I am going to prepare him in the morning....and take him and bring him home getting him thru the post op etc....I am thinking of asking my Dad if I can have someone come stay with him from when he gets home until he goes to bed...and if he can pay that person....
Today he said that he is NOT SURE if my Mother is going to help him with the drops and he said he doesn't know how to put drops in his eyes and that he never has...I told him no worries...we will figure out the drops...He said how? And what i got from YOU on this site was the ANSWER...We will practice with SALINE
We did get the earliest times for the surgery on both days...Mondays and one after the other.
Thank you for your help and responding to the post.
JustlikeMom...good idea to reply to the persons post....with the name...it IS annoying to scroll all the way thru these threads....
I don't think the site has very many options for posting....its harder to use than most sites I use...but I can adapt....anything to make life easier
Your eye Drs office sounded like it was in the middle of a shuffle while your Husband was going thru his surgeries... Not sure why you leap to that conclusion. The office staff were great. Even when DH picked up a stomach bug that left him with severe projectile vomiting after his first surgery. We got the aftercare handout that said he wasn't allowed to lift so I was really worried he;d need a 2nd surgery. The doc called me several times the day after to arrange his follow up- he ended up clearing out his office and staying behind with a single RN to check DH. After we left, they scrubbed the place down. He was late for dinner that night for sure. DH's eye surgeon is a professor at one of the top teaching hospitals in the country. I'm pretty persnickety about vision. I took my late father's detached retina issues to Bascom Palmer Eye Institute in Miami. My mother sees a researcher at Boston's Eye and Ear Infirmary for her macular degeneration. DH's surgeon is affiliated with Wills Eye Hospital in Philadelphia.
I would ask the surgeon to lay out the protocol for aftercare; many reveal the care required going forward as it becomes needed to avoid confusion. My father had a bad outcome from cataract surgery and lost vision in one eye which impacted his depth perception and balance to a significant degree. That said. Depending where they are on the dementia journey, sometimes vision problems are a function of brain damage rather than physical issues with the eye.