Eyeworld

EW CATARACT 38 February 2015 with sensory deprivation, Dr. Lerner said. He also thinks the practical aspect of better vision—for example, seeing that the person coming to- ward you in a dark room is a family member and not an intruder—leads to more positive outcomes. "Our findings suggest the need to aggressively address dementia comorbidities such as cataract im- pairing vision while balancing safety and medical risks," Dr. Lerner said. "Patients may not complain about not seeing, but once the cat- aract is out, they [function] better," said study co-investigator Julie Belkin, MD, assistant professor of ophthalmology, Case Western Re- serve University School of Medicine. The Alzheimer's Association weighed in on the study's prelimi- nary results. "The study supports the Alzheimer's Association view that people with dementia retain and benefit from full healthcare treat- ment. Too common attitudes such as 'There's no need for extra care' or 'Why put them through all of that' are not justified and are bad medical practice," said Maria Carrillo, PhD, the association's vice president of medical and scientific relations, in a press release. Steve Safran, MD, Lawrencev- ille, N.J., was not surprised by the study's findings. "I've seen quite dementia and ophthalmology clinics in the Cleveland area, either had immediate surgery following recruit- ment into the trial (28 subjects) or they delayed or refused surgery (14 subjects). Investigators evaluated vision and cognitive status at base- line and 6 months later. Primary outcomes measures were visual acuity and vision-related quality of life as measured with the VF-14. The subjects who had cataract surgery had improved visual acuity, and they also had an improvement on the VF-14 of +5.5 in the immedi- ate surgery group compared to –4.9 in the delayed group. Subjects who had immediate cataract surgery maintained their score on the Mini-Mental State Examination, but those who delayed or refused surgery had an average score decline of 2.5 points. Patients in the immediate surgery group also declined less on a test called the Alzheimer's Disease Cooperative Study–Activities of Daily Living, and total neuropsychi- atric inventory and caregiver distress scores went down. The subjects who had imme- diate cataract surgery had fewer behavioral symptoms such as hal- lucinations, delusions, and anxiety, Dr. Lerner said. Some of the benefits of cataract surgery may relate to the problems anyone can experience Findings are part of ongoing clinical trial C ataract surgeons are often hesitant to perform sur- gery in patients with de- mentia. The surgeon or the patient's family members may think it is not worth putting their loved one through the hassle of surgery. However, recent study results and results from an upcoming related clinical trial might change that perception. In a cohort of older patients with dementia and clinically sig- nificant cataracts, cataract surgery improved visual acuity, vision-re- lated quality of life, and behavioral symptoms, according to Alan J. Lerner, MD, professor of neurol- ogy, Neurology Institute chair for memory and cognition, University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland. Dr. Lerner and colleagues reported the findings at the Alzheimer's Associa- tion International Conference held in July 2014 in Copenhagen. The results are part of an ongo- ing clinical trial from Case Western Reserve called "Cataract Removal and Alzheimer's Disease." In the results reported in Copenhagen, 42 subjects, all from Cataract editor's corner of the world Study: Cataract surgery improves quality of life in dementia patients by Vanessa Caceres EyeWorld Contributing Writer R ecently a patient with severe dementia was referred to me for possible cataract surgery. Her referring ophthalmologist had known her for years before her vision deteriorated and knew that her cataracts had become quite severe. However, her dementia had escalated to the point that she was now non-verbal except to yell profanities indiscriminately. Her family members were concerned that her dementia was progressing rapidly, and she was becoming more combative. She required an exam as well as all axial length and keratometry measurements while under anesthesia. I would be scheduling her surgery without being able to evaluate her cataract or potential other ocular comorbidities. The staff members in my office and in the operating room questioned why I would schedule such a case. The common question being, what difference would it make to this demented patient whether she had cataract surgery? I have to admit, the scheduling process and preoperative preparation for surgery was very time consuming, and I started to second-guess my decision. However, she did undergo surgery of a very dense brunescent lens that would probably be responsible for vision at the level of about 20/400 or worse. Postoperatively, the family members and caretakers were surprised at her demeanor. She was no longer as combative, and she was able to be consoled much better. She appeared to be enjoying her visual surroundings and was noted to be following what was happening around her. When people investigate the success of cataract surgery, Snellen visual acuity is often the measured outcome. However, most surgeons understand that Snellen acuity alone does not accurately reflect the full benefit of replacing the opacified lens with a clear one. This study by Alan Lerner, MD, at Case Western Reserve University highlights the additional potential benefits of improving sensory deficits in patients with Alzheimer's disease. I believe studies like these are important to fully grasp the intangibles of visual improvement with cataract surgery. Bonnie An Henderson, MD, cataract editor continued on page 40

• Cover