Eyeworld

EW FEATURE 92 Challenging cataract cases • October 2017 AT A GLANCE • Cataract surgery in patients with dementia requires ophthalmologists to take extra considerations during the perioperative period. • Having a caregiver with the legal authority to make decisions for the patient, if applicable, is vital. • Know when patients are still suitable for topical anesthesia or if they'll need general anesthesia. With anesthesia in dementia patients, sometimes less is more. • Try to simplify postop drop regimens as much as possible for patients who have trouble remembering. by Liz Hillman EyeWorld Staff Writer From extra preop prep to anesthesia to target refraction, surgeons explain how they modify their care to best suit these patients W hile there are various ocular factors that can drive the course of cataract surgery, non-ophthalmic factors, such as the patient's mental state, can impact all aspects of the surgery as well as preoperative and postoperative care. forgetful to those who are extremely confused and unable to follow com- mands. Treatment and the surgeon's approach should vary based on the level of dementia. While a physician might be informed that a patient has demen- tia before they even enter the exam room, the physician needs to make their own observations and ask the right questions of the patient Take dementia, the most com- mon form of which is Alzheimer's disease. According to the latest data from the Alzheimer's Association, there are more than 5 million Amer- icans with Alzheimer's. The asso- ciation estimates that this number could reach 16 million by 2050. "With our aging population, the increased prevalence of dementia and cataracts, I am seeing a larger number of patients who have the diagnosis of both dementia and cataract," said Cynthia Matossian, MD, Matossian Eye Associates, Doylestown, Pennsylvania, and adjunct clinical assistant professor of ophthalmology, Temple University School of Medicine, Philadelphia. But, Dr. Matossian continued, there is a spectrum of dementia diagnosis, ranging from those mildly Special considerations for cataract surgery in patients with dementia Monthly Pulse Challenging cataract cases: In the face of ocular comorbidities In patients with moderate to advanced glaucoma with cataracts, I: Perform cataract sur- gery alone as it will lower IOP enough Perform phaco and MIGS Refer to a glaucoma specialist who does MIGS For cataract surgery preop corneal assessment I do: Slit lamp fluorescein or rose bengal stain- ing assessment only Corneal topography Tear osmolarity testing Any of the above combined EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send an online survey covering different topics so readers can see how they compare to our survey. If you would like to join the physicians who take a minute a month to share their views, please send us an email and we will add your name. Email carly@eyeworld.org and put "EW Pulse" in the subject line.

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