My husband with Alzheimer’s may need cataract surgery or new glasses. He can’t always name letters and gets confused. How do I handle that?

My husband had a massive stroke at 48, which left him unable to speak well, or read, so when it came time for his eye exams, thankfully we had a kind and patient optometrist, who figured out what to do. He would only use the eye charts that had the E's on them. Some E's would be pointing down, some sideways, and some up. He would have my husband point with his one good hand, which way the E's were going. That worked very well for my husband, and we never had an issue with his glasses.

I cannot speak much to the cataract surgery, as I never had to deal with that, other than to say, that I would perhaps put that off as long as possible, and maybe just keep getting him stronger glasses, as his eyes get worse. I wish you the best.

You let the examining doctor know your concerns. He will arrange to do the exam differently than he normally would. It is crucial now to be examined for the eyes in terms of any chronic problems that come for elderly (macular degeneration and cataract and glaucoma only a few of those). It is crucial with cataract surgery that you speak with the doctor about how to handle to post op problems as well. Wishing you good luck.

Eloise46, since small children are able to get glasses without knowing all the letters, the same can be done for an adult who can't name the letters. The eye doctor will know how to handle this when you bring up the subject.

I would definitely call your doctor and tell him your concerns. Let them explain when and why surgery for cataracts needs to be done. That office should also contact the eye surgeon you have selected to them them know of the problem. They will need this information so that they can get your husband through the surgery (which is often performed under a local..... yes, it is weird to feel that you are underneath glass and watching it being shattered) and post op exams.
Good luck in your journey.

Go to the eye doctor and just give it a try. Cataracts can be seen by the eye doctor without the patient having to read a chart. Tell the doctor about your concern about him possibly rubbing his eyes. They may have something they can put on the eye, or maybe clear glasses to wear while healing and keep his hand from getting directly to the eye so quickly.

If there's no way to do cataract surgery, it's very difficult to get a good pair of prescription glasses because of the cataracts. Trust me, I've tried for myself. I put off the surgery because of covid and my glasses no longer work for long distance. . .AT ALL. I happened to try on an old pair (that actually belonged to someone else) and found I could use those to drive. My old progressive lenses still work for reading. If his don't, try some varying strengths of readers.

I think you need to think deeply about the immediate post-surgery regimen. You may be correct that he won't be able to NOT rub his eye (they do one eye at a time). There are multiple eye drops that need to be administered multiple times a day for up to 2 weeks (and it's so confusing they actually gave my mom a chart). Then you get to go through it all over again when they do the other eye.

My mom had a post-cataract surgery vision problem which was only corrected through much effort and a Lasik surgery and because she could accurately communicate what was going on. I think you need to get advice from someone who's actually gone through this surgery with an LO with ALZ, as well as the surgeon. I hope you get much helpful info on this topic.

Talk to his eye doctor. They can do tests for people with difficulty reading - kids have an eye test where they have to point in the direction the arrow or letter points.

This is just my feeling.....I would be concerned about having a dementia person go under anesthetic, unless it is a vital operation. I do not think of cataract surgery as vital. Because of his present condition he might not be able to read even after the surgery. I have had cataract surgery and know there was a vision help but really not super major and yes keeping his hands away from touching etc after surgery is very important. But mainly I would be concerned about the anesthetic and brain in its condition.

The anesthesia I had for cataract surgery was barely detectable, and there were no aftereffects, absolutely none.   I also had the surgeries performed by a top ophthalmologist in Michigan.    I was 75 when I had the surgeries.    And unfortunately, I procrastinated too long as I was just so uncomfortable with the thought of anything being done to my eyes.    My vision had deteriorated so much for near distance that I finally had to bite the bullet and get it done.  And I wish I had done so much sooner. 

The eye drops are uncomfortable, and sting; there's no question about it.   But as explained to me by one of the surgery boarders, there's an anti-infectious component to help prevent infection after the surgery.    And to me that's worth a little bit of discomfort.

If he does have cataract surgery, based on the practices I've seen, someone will have to accompany him, stay during the surgery (in a waiting room), then take him home.  He can't drive after the surgery.   

After my first surgery, I couldn't see well at all the following day.  After the second eye was done, I could see well enough to drive. 

But I'd advise being with him before, during and after, and helping to put the eye drops in his eyes.    Play some soft favorite music, or something to relax him and divert his attention from the discomfort.

He will have a patch (like those used decades ago when we got our shots) for the first day, so that would keep his hands away from the eye.    You might rasie the issue of his rubbing his eyes; the doctor or surgery boarders might have suggestion as the eyes shouldn't be rubbed after the surgery.

There's another valuable issue in getting the cataracts removed:   Balance, fall risk, and seeing where he's going, and that's one of the primary factors that affects seniors...falling or tripping.

Another consideration I would add.  Assuming he would still wear glasses after the surgery, but of a lesser strength, get them from a real eye doctor and not one of the eye places.    My great optometrist retired and I wasn't comfortable trying to find a new one without friends' references, and I had used a commercial eye store before, so I opted for that.

I wouldn't do it again.    So you might want to line up an optometrist to order and fit his post surgical glasses.

I know exactly what you are going through!My sister who has Alzheimer’s would not wear her hearing aids! She drowned one when she was in the shower - some times she would hide the one she was wearing!She then would leave her glasses down & forget where they were!She would take her teeth out & forget that they were not in her mouth!That was about seven years ago! Now fast forward to now
she does not wear her glasses , or her dentures, or her hearing aids!
She is in a nursing home ,content & happy see sees well without her
glasses,— she can hear if you talk loud & still does not wear her dentures
She does not know me anymore ,she is on puréed foods ,does not walk
& is in a wheelchair!My sister is 76 years old! Alzheimer’s robbed her of
her hearing ,eating & walking!It is a terrible disease to have!
The nursing home takes very good care of her—I could never be able to care for her!

When my mom had cataract surgery she was not put under, but she had to be able to stay very still during the procedure. At one point she coughed (because she has allergies and didn't think to take her pill) and this caused a problem and the team was not able to finish a portion of the procedure (it was an optional "fix", more than the normal cataract surgery). Please consider this in your husband's case.

Suggestion for the hearing aides ( my 95 yr old Mom deep into her Alzheimer's journey, ate one of hers. The aide got it out if her mouth before she swallowed the battery) . Have the audiologist attach a tether to it. One end goes on a loop to the device, a 6 to 8 inch thin, clear plastic leash with an alligator clip attaches to the back of the shirt or collar. When they take it out if their ear it just hangs from the tether. Good luck. My Mom also stepped on and broke her glasses. I could not replace them because her prescription was too old. She is blind in one eye ( macular degeneration) but manages with no glasses now for 2 years. The brain at this point can not process what she sees. It is just a horrible disease all around.

Definitely talk with the ophthalmologist about the concerns for the surgery AND post surgery care. If he can't sit still for the surgery, that would be bad. If he can't stop touching his eyes, that would also be bad. As long as possible, I would try to keep up with exams at the least, because there are other conditions to worry about.

Up until mom's stroke, I kept up her Mac Deg treatments, every 4 months (she'd been doing this for many years before dementia, so it wasn't totally foreign to her.) The only real vision exams were done as part of the "treatment" - it was hard getting through some of it, due to hearing issues and dementia, but not too bad.

At his stage and condition, it might not be worth doing the cataract surgery. I know that my ophthalmologist told me I would need it done in about 10 years (maybe 5 years ago?) So far it only impacts driving at night, esp in the rain on dark roads, worst with on-coming traffic! So now I try to avoid driving far at night. I didn't want to get it done in case my mother needed me for anything.

Since it's not likely he is driving and distance vision isn't as important, it may be best not to put him through that. He may not grasp what they're doing, get restless mid-surgery, and will definitely be a problem post surgery. DO get all the exams done and see what options there are for helping his vision for now.

I'm not looking forward to it myself... It will be nice if they can correct my close vision - I don't drive as much now, so only having to need distance glasses will be nice!

There are vision tests for young children who don't read yet which use icons like hearts and suns. If he can recognize shapes, that might work. I had cataract surgery, and I had trouble keeping still on the second surgery; they loaded me up with some tranquilizer. I don't remember a thing. I'm pretty sure the opthalmologist has dealt with difficult patients before. I'd be more worried about keeping the eye guard taped on. It might not be worth that struggle. Short of keeping someone unconscious for about 24 hours, there's really nothing you can do to ensure that the eye stays protected. And knocking people out is not a safe idea.

The'll handle an eye test like a child's test.

The cataract surgery will be ok and they'll hzve an eye shield fir him to wear. You might even have him wear his glasses 24 7 and have him sleep in a Recliner for a couple nights

Well he's not going to stick his eyeball down the garbage disposal - !

The best thing you can do is rely on the advice and considerable expertise of the ophthalmic team, bearing in mind that a sizeable proportion of their patient group will have comparable difficulties with cognition and compliance.

With the vision test, cross your fingers and hope for a "good" day; be prepared to abort the mission if it isn't going well and just rebook the appointment. By all means let the optician know in advance that a little extra patience may be required, but they have alternative methods for patients who can't read letters (or not reliably).

Pre surgery - explain the problem and take advice. There are several possibilities, including ventilated plastic eye shields which can be taped in place with micropore tape; these work mainly by being a "reminder" to the patient not to touch the eye, and it may be that your husband will be more tempted to reach to his eye because the shield bothers him, but these are bridges to cross when you come to them.

Are you good at putting in eye drops?!

If he is still with it enough to follow basic instructions, and if his cataracts are so bad they interfere with his activities, it may be a good time to do one because poor vision is also a fall risk. They do one eye at a time. You need to direct these questions to his eye specialist to get an idea of risk versus benefit, and they do eye exams for people with cognition issues all the time.

Just my 2 cents here. I agree that with Dementia cataract surgery will be a challenge. First, you don't go under for surgery. Its a local in the eye. Second, you can choose to be able to see without using glasses. You pay extra for that. You can have where you see but use readers and I think you can have bifocals so no need for glasses.

My nephew had glasses at 8 months. I asked the doctor how he could exam him since he couldn't read or talk. He said by the way the eye refraxs the light. So, make it known when you make the appt that Dad can not read anymore and gets upset. My Mom had a hard time comprehending what she read but I think she would have been able to read one letter at a time when reading an eye chart. I am sure his eye doctor will know how to get around it.

My mother with advanced dementia lost her ability to read and then stopped wearing her glasses. Her world has gotten very small. At some point, she could no longer take an eye exam. I asked the eye doctor what they do when a young child who can't read takes an eye exam. We tried that, but my mother's comprehension was not adequate to understand what she was supposed to do. Talk to your doctor before your husband has any eye surgery. This may just be a symptom of his decline in understanding.

Reading will be less not better, which is why they tell you up front you may also need reading glasses. I’m wondering if the anesthesia on a dementia patient is a concern bc this is not something I’d even consider. Jmho

Hi, I've just been through this with my dad who is 80. He had one cateract removed end of November and it was the experience of coming out of hospital and having no proper glasses after that was such a problem! They sent him out with his glasses all crooked on top of his head and gave me instructions of antibiotic eyedrops to be done 4 times a day! He also has to take glaucoma drops at night! This all became part of a nightmare and then despite the cateract surgery apparently being a success, he hasn't noticed any benefits! 5 weeks after they gave him the all clear and we went to get new glasses and now he has one eye so weak and one eye with fantastic distance vision. Now that creates a new problem, if the optician prescribed the the real lense needed for the weak eye he gets double vision. So he ended up with a weaker prescription than needed and now says the glasses are next to useless. He is on the waiting list for the other cateract and I'm left feeling whether I could take this again or if he could indeed cope? The whole experience seems to have hastened dementia symtons. Think carefully before going ahead. Will you be able to cope and will he benefit or not? Best of luck with it all.

My 89 yr old mother with dementia had eye surgery and had a vented plastic dome patch taped over her eye. She removed it every night, even after using strong tape and wrapping her head. So, you have a real concern about him rubbing his eyes after the surgery. We ended up taking turns sitting with her 24/7 to keep the patch on. It wasn't easy. I wish you well.

I had cataract surgery less than three months ago. The anesthesia is definitely NOT just local; even though it was a fairly minimal amount, they put me to sleep. They also strapped my arms to the operating table so that I wouldn't reach up while unconscious to touch my eyes. By the way, a reputable doctor will usually only do one eye at a time, in case there are complications, so you'll need to plan for two surgeries. This means two recovery periods also.

After the surgery, I did wear the eye cup for a day or two and also at night for a week. It will require a sustained effort to administer the drops four times a day for a week, then three times a day for another week, then two ... and finally one. For at least the first week you'll have to find a way to keep his hands away from his eyes, which will actually have an open flap on the cornea until they heal.

I would think long and hard before having someone with dementia get this surgery. If it's purely for reading, you should be aware that Medicare ONLY pays for two eyes to be corrected for distance. This leaves you with the same problem as before—the patient will not be able to read without glasses. And are you even sure that he will continue wanting to read or will understand what he reads? Maybe it's time to explore listening to NPR radio (National Public Radio), where there are many human interest stories, or tuning in to a cable TV station (like Turner Broadcasting) that features old movies. It seems as if these would be far more enjoyable to him.

I'm in the Cleveland area and heard we had an eye MD who was actually concerned/researching the issue of eye problems on the dementia and Alzheimer's type illness patients. But aside from that I have been patronizing one of the eye glass places in our local mall who has an optometrist with excellent reviews. They actually have a piece of equipment now that can "read" your prescription needs without all the which is better routine. He was explaining to me how beneficial it was particularly when I mentioned my mother with dementia, and how it helped his own brother who had some cognitive challenges and tended to be agreeable to whatever was said /asked of him. As for the hearing, I have been through this with my deaf father. I was annoyed at a well regarded medical center when they needed guidance on how to figure it all out, but basically we communicated by writing him a note that said which is better, 1 or 2 and by demonstrating by holding up 1 or 2 fingers. Of course he is mentally with it so could do that....I'd touch base with your local Alzheimer's Assn and see if they know anyone who is especially good with the situation, or ask if they know of a good neurologist and check there, short of that just looking up opthamologists in your area and calling around and asking. Note also that my ambitious father had TWO cataracts done just weeks apart and I was his escort...due to the hearing issue I was allowed "in back" which made it easier for them to get answers to the pre procedure questions they typically ask. In addition, depending on where and who does it, if IV sedation is involved, the worst part of the whole thing for my dad was being traumatized when a very stupid staff secured the line with super adhesive tape on his very hairy arms and then another person just ripped it off of him in spite of my warning and asking for a scissors so I could slowly cut through the hairs to get it off. Beware there is an outstanding tape product made by 3M and you can order it from wound care supply places called KIND. AMazingly it holds, but does NOT stick to hair (think of the adhesive like in a post it note. By the time of the 2nd eye being done I had some on hand and offered it to the staff who used it. It's a very small roll and expensive....but it's worth it. Really sorry to hear about the hearing aid....my mom had two and they vanished. Probably threw them out. We opted not to replace. Too hard to keep watch on her every second and our city provided trash bins are huge--to huge to go through routinely to look. In fact, we have one for trash and one for recycling. On my own I discovered some locks with super sticky adhesive that we attached to the bins, they have small cables with loops in the end you can run a padlock or combination lock through. SO that way at least we eliminated one place we had to look for missing items. Have slowly discovered the relief from locking her out of rooms or places. Unfortunately our biggest issue is the kitchen, in particular the fridge where she is entertaining herself by taking all sorts of things to eat or graze or drink on. The toddler fridge lock was a total failure, she just used all her might and yanked it open. Dad refuses to lock her out of the kitchen which is the only answer. Good luck.

Eloise, since there are so many different experiences here, I think you need to talk to the Ophthalmologist who will be doing the surgery. He is an MD unlike a Optometrist who is not. Here is a very good article explaining what is involved in Cataract surgery.

https://www.health.harvard.edu/diseases-and-conditions/considering-cataract-surgery-what-you-should-know

Craftlady's experience seems a little extreme. I am 71 and besides parents I have a number of friends who have had the procedure done and recently. All said the procedure went well.

The article mentions the different types of lenses there are. Medicare only pays for one type. The others the patient pays out of pocket.

My BIL is my optometrist and when he does exams, along with the glaucoma test (the poof of air on your eyeball) he does a check to see where your current vision issues are with a vision checker (that's not the name, I don't know what it's called) Then he does the more 'in depth check'.

He did tell me that the one done by 'machine' was almost always so very close to his in depth one that for patients with anxiety or ones unable to read the eye charts--he could prescribe glasses and feel he'd done as well as could be done.

Of course, w/o the 'personal exam' you cannot see any internal workings of the eyes, the beginnings of cataracts, 'floaties', etc. The best case is a thorough exam. Second best is the vision 'machine' and you can rest easy knowing that's 'good enough'.

Any patient who has issues outside his realm, he refers out. A lot is the cost, as he is affilitated with a large nationwide vision co. Opthamologists are generally 'stand alone' practices, maybe having a small glasses store in partnership, but they aren't in the biz to sell glasses, they're there to check your eye health on a deeper level.

Other than partially sedating your dad so he can be compliant for the few days post surgery--wow, I don't know how you'd keep him from fiddling with his eyes.

I read most of the comments, so of course I have to put my 2 cents worth in.

Both my husband and I have had the surgery. They did put both of us out. Something I was happy about. The first time for me I didn't go all the way out and the Surgeon was mad because he didn't have his usual Anesthesiologist. We weren't out long.

My concern is post op. If there is a chance that he can't follow orders, I wouldn't do it. I had a friend whose surgery went bad and the has lifelong problems with that eye. It sounds to me like he would not be able to follow instructions and are you prepared to stand there overnight and watch him every second to see that he doesn't pull the bandage off? Will he let you put drops in his eyes for a week or two?

Imho, you should definitely ask his opthamologist these questions. To undergo cataract surgery, which involves removing the old, damaged lens and putting in an artificial lens is done in two separate surgeries (one for right eye and one for left eye). All told, it will involve typically a total of 7 visits and putting drops in the eyes for 28 days, depending on your surgeon. The anesthesia is a local. They do NOT put the brain to sleep for cataract surgery.

NOTE: there is a concern for OP below, marked with **

Being that sometime soon I will need this done, I was interested in the link Joann29 posted. Sadly, just when it gets to the part that is interesting, it requires you to log in. GAK! I have way too many accounts now, I don't need another! So, I copy/pasted the title and there are other sites to get info. So far I've read these:

https://www.consumerreports.org/cataract-surgery/cataract-surgery-what-you-should-know/
https://www.mayoclinic.org/tests-procedures/cataract-surgery/about/pac-20384765

I knew my mother didn't need her old glasses (they were bi-focal) after she had this done, but still needed reading glasses. I had read pamphlets when taking mom for Mac Deg treatments, so I knew you could pay for additional, but...

"Standard monofocal lenses, which usually help with distance vision, are often included in the price of surgery and provide excellent clarity. But you may still need glasses for reading afterward..."

**THIS would be a concern for OP's situation. If the standard is correcting distance vision, is this really going to help? Maybe 4K or more to correct near vision too, and on top of that, how would he do with post-surgery care?

My preference would be to correct the close vision and just require glasses for distance, as I read WAY more than I drive. I had read pamphlets when taking mom for Mac Deg treatments, so I knew you could pay for additional, but...

"Multifocal lenses, which can help with near and far vision, may eliminate the need for eyeglasses but can cost more than $2,000 PER EYE out of pocket. And you may still have difficulties with nighttime driving glare afterward."

D*mned if you do, d*mned if you don't! With my first distance Rx, the place I bought the glasses asked bi-focal or progressive. I said neither, just the distance. But it says... Nope, I use $1 readers that can be cheaply and easily replaced, just the distance. The next time I decided to try the bi-focals. NEVER again. I absolutely hate them. Driving into afternoon sunset, being short, I have to tilt my head in such a way to get benefit of the visor, with the result that I'm looking through the reading part. It's more than just that, but I really do detest them!

So, I'm going to have to ask if they can correct the close vision, with good results and leave the distance to specs...

As for sedation, it says:

"Most people receive a light sedative and an anesthetic to numb the eye..." The only "sedation" I had one time (did NOT want general) actually put me out - I don't remember anything after the bzzzz feeling like I just had 3 beers! I'm sure there are places that might opt to actually put you under general. I avoid it like plague, because even with anti-emetic, I throw up EVERY time after (the anti-emetic delayed it until I got home.)

On top of that, I have "lazy eye". Not sure how that might impact things...

Topic older (4+ years) and closed to comments, but:

https://www.agingcare.com/questions/dangerous-for-alzheimers-patient-to-have-cataracts-removed-208939.htm?orderby=recent