Eye Blog

05/04/18
Last week I had two interesting and very different encounters with patients which once more raised the dilemma of performing cataract surgery in persons suffering from dementia. This can be fraught with a myriad of issues such as obtaining informed consent for surgery, deciding on whether to put the patient to sleep or not, assessing whether there is any clinical benefit to the procedure, organising post-operative care and managing expectations in a patient with impaired mental capacity. As doctors we are taught to 'do no harm' and to always put the 'best interests of the patient' first.

Families are often at a loss, wanting the best, but not always able to grasp the complexity of the process. The first encounter was with a sweet and endearing gentleman with mild dementia who was well supported by both his family and a team of competent carers. He happily placed his faith in my ability as an experienced cataract surgeon and was thrilled with the results when he attended his post-operative visit. He presented me with a bouquet of flowers and expressed his heart-felt thanks. It reminded me of why I love doing my job.

The second encounter involved a patient that I had treated for nearly two years for macular degeneration. She had always been a force to reckon with but in recent times appeared to be developing signs of early dementia. I agreed to perform cataract surgery with the help of sedation and this proceeded without event. However, after her operation she grew very agitated and abusive despite reassurances that her surgery had gone well. It was quite distressing for all.

Which brings me back to the question, is cataract surgery in dementia patients a help or a hindrance? My own experience is that patients with mild dementia, controlled on treatment, do very well with cataract surgery. It improves the quality of their life and is worth the initial challenges it may present. In severe dementia, where the patient has withdrawn from external stimulus, cataract surgery is best avoided. In untreated/ undiagnosed dementia, if the patient is unpredictable and emotionally labile, I strongly believe that cataract surgery should be delayed until a full assessment of mental health has been carried out and appropriate treatment initiated.

For further information please go to the RNIB or Macular Society websites by clicking the links below.