Should I strongly encourage cataract surgery for my mom?

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Should I strongly encourage cataract surgery for my mom?

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She has moderate dementia but is in denial. She has a recent history of multiple falls, recently was hospitalized for 3 broken ribs. Her eyesight is poor, but she thinks it's fine. Her doc is recommending cataract removal, but she doesn't believe she needs it. I believe it would be beneficial, but I'm not sure how well she'll deal with wearing an eye patch, etc. How strongly should I push?

Cataracts Fall Prevention Medical Care Vision & Eye Disease

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I’d leave Mom alone . She’s not complaining about her eyesight . Don’t upset her with a procedure . She may not be cooperative either .
Falls come with dementia anyway ,

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Reply to waytomisery

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This is a question you need to ask an Opthamologist. Cateracts will cause blindness. My husband just had his done. There was no patch. Lots of eyedrops for the next 5 weeks. The procedure itself takes 10 min. My DH was in and out in an hour. Her fallscould be caused by not seeing well.

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Reply to JoAnn29

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JoAnn, did your husband have to be careful about bending over or anything like that?

It has been a couple of decades since my granny in law had hers done and I remember her saying she couldn't lift much and couldn't bend over. Curious if the after care is the same.

I think that is the biggest challenge when dementia is involved.

Thanx for the information.

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My daddy kept bumping into things because the cateracts were bad. Once he had it done I just made sure he never bent over, he had slide on shoes and placed eye drops in his eyes three times a day. To me it was easy and the surgery was faster than anything. I sat down and they called me to let me know he was ready to get dressed and go. He wanted to drive and I had to tell him I was driving hee hee! He was fine with going places - he wanted to go shopping so we did. Yes he was tired after that but he was also 83 years old. If her doctor recommends it - do it! Quality of life!

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Reply to Ohwow323

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Thank you.

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Eye surgery usually requires self control to avoid wanting to touch, scratch, finger the eye area, and accept drops. If M’s ‘moderate dementia’ means that she won’t do that, it might be best to avoid it. The risk is not the surgery itself, it’s what happens afterwards. I and also my DH have both had eye problems. Mine took 10 days of self control for a detached retina, DH’s about a day for a wet macula (but multiple times).

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Reply to MargaretMcKen

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Thank you.

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I have a SIL whose vision was so poor from cataracts that she had to be hospitalized for removal of the first cataract. Legally blind. She has never had the second one removed although it was truly life altering for her to be able to see again. Vision is a bit subjective. We can become accustomed to our current vision and not realize just how much help we need.
Interesting comments on this regarding corrective lens and cataract surgery on second link attached.

The cataract does not quit growing so it will get worse. Also how are her eyelids? If they are droopy, that can affect her vision as well. Original medicare will cover surgery to correct that problem.

A lot of this decision for me would depend on the degree of dementia, the age and comorbiditie, etc. You don’t provide that info in your bio.

There is a good article on PubMed about the anesthesia used that is worth reading. Local vs General for those with dementia having cataract surgery. Link below.

After reading this I would be careful which doctor I listened to and their experience level. If your mom is young old (65-74) or even mid old (75-84) she could live a very long time and be totally dependent. Especially if blindness and mobility issues are her only comorbidities.

Plenty of elderly fall with great vision so it may or may not prevent that. My SIL just broke one ankle and sprained the other from a fall where she was wearing slippers and coming up steps from outside. Probably had been out to smoke. So some w/o dementia are in great denial. Now she’s with a hard cast on one leg, a boot on the other. Not sure what creative measures she is going through to smoke outdoors now. We don’t memtion the S word when we chat.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4196883/

https://stephenberryart.com/blog/2020/3/28/the-subjectivity-of-vision-or-what-happened-when-i-got-glasses

Let us know what you decide and how you made your decision. We learn from one another.

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Reply to 97yroldmom

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Thank you. Mom does have CKD and COPD. She also has glaucoma which may be corrected during cataract surgery. I'll be speaking with my sister next week. I'll update on the decision.

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I had my dad with dementia get his one eye done and it worked out fine. In our case it took half the day because of how the doctor lined her patients up for the procedure. My grandmother never followed through with hers, and became blind later . . . at which point she was already in nursing care facility.

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Reply to RMJ1977

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Thank you.

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Tough call. I think it all comes down to how cooperative she will be with the aftercare. My dad had two cataract surgeries and a third eye surgery all in one year, while his dementia was mild and before it was diagnosed. He was so-so with cooperating with the eye drops and other protocols at that point. The operations all turned out “successful” and he didn’t even need glasses after a lifetime of wearing them. But then within 2-3 years, his brain’s abilities to process the info from his eyes was messed up by the frontotemporal dementia. He could be looking right at something (say a coffee cup) right in front of him, and still could not register that it was right there. Or sometimes he would feel his way along the walls. The ophthalmologist said his eyes were fine. His brain became the issue. Once the dementia advanced, he became more uncooperative like hiding pills, spitting them out, refusing to bathe or even wash his hands. And constantly picking his face. If the operation had been suggested at that stage I would have said no with him.

good luck!

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Reply to Suzy23

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Such difficult decisions. Thank you for your response.

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Her falls are much more likely due to the aging brain, which loses balance. I would discuss both with her eye MD and with a neurologist. Corrected vision, while a real boon to those who need it, do often have no effect whatsoever on the numbers of falls.

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Reply to AlvaDeer

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Thank you.

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I’ve been thinking about this some more . Have you tried to see if she would be cooperative with the eye drops ? .You could maybe just try some artificial tears multiple times a day , just as a test . My initial thought had been that she would not be cooperative . But maybe you could try this ?? The eye drops are very important as well as not rubbing the eyes post procedure .

You would have to ask the doctor how bad they are , as far as going blind . Some go faster than others . My Dad never did his, , didn’t go blind , died at 88.

FWIW , my sister had her cataracts removed last year at 69 years old just before approaching moderate Lewy Body Dementia . Since then has had multiple falls due to the dementia .

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Reply to waytomisery

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Thanks for your response. Mom takes eyedrops for glaucoma, so eyedrops should not be a problem. And they might actually be able to fix the glaucoma during the cataract surgery.

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Most important, she will need to stay perfectly still during the procedure. My Mom got a sedative but was conscious during the 5-ish minutes it took to perform. I'm assuming she's not in a facility where the staff would be needing to put the drops in. I think the drop "schedule" is not at challenging as it was ever 5 years ago when my Mom had it done. If it is, and you're the one to be putting them in, are you willing/able to do it? I agree with those who point out that she needs to resist taking off the protective glasses and rubbing her eye. For my Mom's they did one eye at a time with 3 (or 6?) weeks in between. I'm all for helping her to retain her eyesight. I also agree it probably won't impact the falling issue since that has multiple causes.

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Reply to Geaton777

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There are ophthalmologists who instill the drops in the eye where the cataract is being removed during the cataract removal surgery. I shouldn't need this surgery for many years, but I see an optometrist who is an adjunct professor at our local college of optometry. He told me about them. He also said theit practice never refers patients to any opthalmologist that doesn't do this, Ask around. She might not need the drops.

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One thing I want to caution about. Cataract surgery can have complications, my dad lost his vision in 1 eye because he didn't get to the surgeon as soon as the problem started, a dear friend would have lost his sight if his RN wife didn't say, no, blurry vision with black spots is NOT normal.

If she can not articulate that she is having an issue, if she develops a complication it could end poorly.

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Reply to Isthisrealyreal

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Thank you.

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If you are willing to stay with her day and night to help her -
instill her eye drops,
keep her from bending over to reach floor, feet, low objects...
giver her medication when she has pain (which will be minimal),
keep her hands away from her face (distraction with movies, games, activities),

Then please do so.

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Reply to Taarna

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Thank you.

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Hi answering based on recent experience & from Alberta, Canada. My Mom has been living with dementia since 2019 (official diagnosis) but probably longer. Currently she's been living with me since 2022 and dementia is at the advanced stage. She's still eating, is incontinence, mostly speaking her cultural Language which I don't fully understand. My mom has always been wearing glasses but in the last 3-4 yrs hasn't. For a while she was saying "they don't do anything". In 2023, we did have a consult for cataract surgery but the opthalmologist wasn't helpful, leading to a very frustrating, negative experience.
My mom's depth perception is off, when trying to grab things, because of poor vision, she doesn't like to eat dark green vegetables even though she's a vegetarian, she's afraid of some images on the tv. She's walking into things. So I suspect things are just looking very distorted to her.

This wk (April 15) we met with a different Opthalmologist who we were referred to by an optometrist. Part of the visit involved testing by a technician first but that couldn't be fully done as my mom wouldn't be still. Even attempting to put eye drops in was beyond challenging. Later on Opthalmologist came in, I had to restrain my mom so she could get a better look at her eyes and confirmed it is indeed cataract (the left eye is worse than right). They will have to administer general anesthesia and was informed drops will be put in as part of the surgery but will not be given after (at home) as she may rub her eyes making things worse. Just awaiting on surgery to be scheduled. They said within 2-3 months but hopefully sooner if cancellations take place.

I'm no expert but my recommendation is to schedule an appointment with an Opthalmologist. Not sure where you're located but here in Canada one has to see an optometrist first then get a referral with a specialist (opthalmologist).
If I can be candid I'm a little annoyed I waited this long to reschedule with a different optometrist but I went with a recommendation from one of her caregivers as I didn't want to have a similar experience as the last. So if you're questioning if you should schedule an appointment, just do it now if you haven't yet. Even if she's combative just know you're doing it with positive intentions. At least the specialist can confirm.

As for falls haven't experienced that yet but wondering if taking your mom to physiotherapy is an option for balance exercises to help with mobility. I did so before (2023) when my mom was experiencing pain in her hand & wasn't able to remove her clothes to use toilet & it helped. I'm taking her back physio this wk as she's starting to lean to the left, & confirmed she's in pain. I suspect the pain is from how she sleeps..finding her in awkward sleeping positions, putting more weight to the left side and having to readjust her through the night.

Happy to followup with you once she gets a date for the cataract procedure if you're interested.

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Reply to Jennkiura

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Thank you.

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My last neighbours mother refused to have an op for her eyes. She had a few serious falls. It turned out she was plain scared. Thought if she went into hospital she wasnt coming back out.
She also refused to wear glasses. Her son was in despair. I tried to help and she listened to get some glasses to enable her to do things. She never did have the op. Her decision but did agree glasses.
Depending on her health - maybe thats the route - to get by with glasses.
My neighbour had me as an outsider to speak to his mother. She wouldnt listen to family. Is there someone else who can talk to your mother. My conversation was to pretend i was suffering and couldnt read my magazines and books.
Maybe to suffice with glasses
or get someone to talk to her
My dad years ago had laser on eyes. he could have easily persuaded the neighbours mother that it as no big deal and the benefits out weighed
Sometimes the only option is to allow someone to make their own choices in life and you support them from that perspective.
Speak to mother doctor and see what they say.

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Reply to Jenny10

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Thank you.

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Sight is very important. My mom had wet macular Degeneration and severe cataracts. My mom's eye surgeon referred her to someone else because he felt that she was too much of a risk due to her age. My mom was unable to receive cataract surgery due to a high risk from general anesthesia. I would say that if the eye surgeon is requiring general anesthesia, it's going to cause your mom's Dementia to get worse.

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Reply to Onlychild2024

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In my opinion since I have had cataract surgery myself and also have a mother who has dementia my question is do you think her falls are because of her eyesight? If her dementia is mild, is there a possibility that there can be help for her mentally? I know that sounds bizarre, but I do also know that eyesight is very important to the state of the mind. Sometimes visual problems are brain related as well. I also know that anesthesia can actually trigger dementia.

My mother got dementia after her hip surgery. She was never the same after that. I had her get an MRI and they said she had small vessel disease in her head. I think lots of times dementia can be helped if it’s caused by something else. I’m not a doctor, so I have no idea. I have considered getting my mother eyes checked for cataracts because she’s never been told she had them. I have had cataracts removed because of damage to my eyes from a horrible doctor. I think my mother‘s depression is much worse because she cannot see that good and she is always hiding and losing her glasses. She is a very hard person to deal with.

I think not being able to see can really make mental issues worse. Of course this is my opinion. If you think your mother could handle the anesthesia and her falls are vision related, I would definitely consider it. As far as the eyepatch, I didn’t need one. I think it also makes a huge difference on the doctor that you have.

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Reply to Hopiegirl

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my stepfather had light dementia until a broken hip, then after the surgery he went downhill fast. The anesthesia exacerbated his dementia.

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My 87 yo mother had double cataract surgery last year, and she was just fine. I made sure that she got the required eye drops for the next week. The clear plastic eye cover only had to be worn the first night. Her vision is so much better now. She had become used to the cataracts and did not realize that her vision had deteriorated because of them. I had mine done last year as well (I'm 69). The surgery was quick and easy with very little discomfort afterwards. Neither mom or I were completely put under with the anesthesia.

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Reply to LHnHTX

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Surgery may scare your Mom and not worth asking for her recovery cooperation. Impossible with dementia.

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Reply to Patathome01

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I have had early stages cataracts since age 60 and spend less time driving at night. I live alone and will ask my opthamologist with my annual vision exams when cataract surgery will be necessary since a family member from out of state may have to fly in to care for me during my recovery of both eyes. No surgeon will schedule me without help! Not sure if a local friend will commit to helping me. Hired caregivers or temp. facility costs, even for a few days on my fixed income, are out of the question. I Have To remain independent for as long as possible at age 69.

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Reply to Patathome01

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We all respond to the world as we perceive it. If Mom can't see, she will be less responsive. This will impact her spatial awareness and she won't know where she is, where things are, not just acuity (detailed eyesight). Poor vision means poor depth perception. Vision and hearing problems greatly exacerbate dementia. If Mom's overall health is good get the cataracts out. They can use a clear patch so she doesn't have her eye covered and won't be upset about not seeing at all out of that eye for one day. I would suggest getting both eyes done at one time. Many doctors won't do this, but with Mom you may only get one chance. If she is likely to refuse to wear glasses afterwards, have them put in multifocal implants. If Mom can't cover that expense and still reads or uses an iPad, have her corrected to -1.00. Her sight very near and very far will be a little blurry without correction, but she will see well enough to move around independently and see larger print uncorrected. PM me for more suggestions.

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Reply to DrBenshir

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UPDATE

We went forward with the surgery. No eyedrops were needed, but she did have to wear a funky eye cover for four nights after each surgery. She fought this after the first eye, but she eventually agreed. After the first eye, we removed the one lens from her glasses so she could see with her "bad" eye. After the second eye, we removed the other lens because she insisted on wearing glasses. So she is currently walking around with glasses on and no lenses. Her new glasses will be available soon.

She was not given a general anesthesia during surgery, just a sedative. It took about 90 minutes for her to return to her "normal" state afterwards. If I had to go through it again, I would. I feel much better about her ability to see now. It wasn't easy, but what is really? Thank you, all, for your advice.

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Reply to Wenfo623

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Wen, thank you for the update.

Were they able to fix the glaucoma with the surgery?

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Glad it all went well. My husband and I, 75 and 78, just had ours done, no coverings but drops for 4 weeks each eye. Husband saw no difference but he didn't need glasses 24/7, mainly readers. He got the standard lenses. I have worn glasses since I was 6. Then contacts at 20 till my surgery. I had to have correction. I think I see better than I have my whole life. Even with wearing glasses and contacts.

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Reply to JoAnn29

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Should I strongly encourage cataract surgery for my mom?

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