My husband is having laser eye surgery tomorrow. A no brainer. Either the surgery or instant blindness anytime. It is called Peripheral Iridotomy and is caused by a narrowing of some vessels around the eyes. He has been watching it for a few years and now is the time. He said it is outpatient clinic surgery lasting about 5 minute with numbing. Sounds something like cataract surgery. One eye tomorrow and the other eye next week.
I am hoping and praying for no complications. Husband is in good spirits about it and doesn't seem to be worried. Eye surgery terrifies me. I will let you know how it goes.
It sounds like your husband has anatomically narrow anterior chamber angles. The anterior chamber angle is formed where the anterior face of the iris and the back surface of the cornea intersect. The angle contains a meshwork (trabecular meshwork) where the aqueous fluid drains from the eye. If the meshwork becomes blocked there is nowhere for the aqueous fluid to drain and the eye pressure can increase dramatically over a very short period of time. This is called an acute angle closure attack/glaucoma.
A peripheral laser iridotomy is a relatively simple in-office procedure where a slit-lamp mounted YAG laser is used to create 2-3 holes in the peripheral iris. These holes allow a more direct route for the aqueous fluid to get to the anterior chamber meshwork and thus help prevent an angle closure attack. (It's a little more complicated than that but I won't bore you with the details.)
Please don't worry about the procedure. It's quick, simple and painless. You'll be amazed at how fast the procedure is completed. It's nothing like cataract surgery. You'll be out of the office within an hour.
Thank you iggy. I appreciate your simple explanation. That is what they told me but you said it in easier to understand language. I really appreciate it. Is this a form of glacouma?
My DH came down with acute glaucoma last year. his pressure had always been normal, but he has had two cornea transplants Because he was blinded during WW2. The first one was in '57, and one of the first ever done. As it was explained to me, there was no opening for the pressure to go, and suddenly his pressure was tremendous, so that he had unbearable pain. he has his eye doctors in the VA hospital, because it was a war injury. i couldn't believe how fast that lazer surgery to make an opening was, actually several openings for the pressure to go out. He still uses the Timolol in that eye, but we have never had another problem, and he just got up after 5 minutes, and walked out of the room. In fact, the lazer machine was right in the examining room, that's how common these proceedures must be nowadays. Afriend of ours who has chronic glaucoma has also had that proceedure. Not to worry. It's all done under a local, and he won't get anesthesia, which we all worry about. Best of luck.
lmohr, it's "closed-angle glaucoma" and my husband had both eyes done a couple of years ago. It's much more simple than cataract surgery. I wasn't allowed to be there for the actual surgery (MOST annoying, I've been good as gold during his Mohs surgeries for skin cancer). He described it this way: They put in eye drops, just as they do for a regular exam. The room is dark and they shine a little pinpoint of light into your eye. It gets bigger and bigger and poof! it's gone. He felt nothing. The laser part lasted, he thought, maybe less than a minute.
I stayed in the special waiting room, with my husband before he was called and then while he was having the iridotomy. There were a bunch of other patients waiting for iridotomies, as well. The first week, no one there had never had the surgery and they were all soooooooooo nervous!!! The next week, ho-hum, yawn, everyone was very calm because it's no big deal at ALL.
You do have to wait around for a while. There is a chance that a little particle that's floating around will clog up the hole that's been created, and then your husband would need to have drops put in his eye. That's why it takes an hour.
And you have to give him eye drops for the next few days. That's it.
I had two cataract surgeries last year. Although it is a bit more involved than what was being described here, frankly, it wasn't all that much more frightening.
The whole eye drop thing goes on longer. A week before and three weeks later. And they use a special surgi-center, so it isn't an office visit. It takes about 2 to 3 hours including prep and post operation. The prep takes longer than the operation does, because they have to wait between sets of drops. But when I had my first one, the person being prepped next to me was on his second and it didn't take him long to calm me down.
We're back from the eye surgery. It went exactly like you all told me. Thank you very much. We do the other one next Wednesday. Now I have the problem of getting the eye drops in his eye. He has to be the world's worse patient to put drops in his eyes.
With cataract surgery you go home wearing a patch. You wear it for 24 hours and then EVERY night for a week. It keeps you from scratching or rubbing your eyes until the new lens has firmed up. There are daily eye drops, 2 or 3 at a time several times a day.
I would not suggest cataract surgery for a dementia patient who is mid-stage 5 or worse, but my husband who was easily mid-stage 5 last year put the drops in my eyes for the full 6 or 7 weeks it took to do both eyes. I don't know what I would have done without his help. It was a good thing I had the surgery when I did because I could not have had it this year.
On the other hand, I had the drop bottles lined up separately and I controlled which bottle he was using on which eye during the two weeks that each eye was getting different drugs. And one of the drugs they use is so dangerous that you can't get it by prescription in a drug store. They give it to you in the kit they give you for pre- and after-care.
Starling, I am going on Tuesday to see the surgeon who will be doing cataract surgery on me. I am not looking forward to the surgery but I know I need it...badly! My eyes are are a mess and I am wondering how it will be with one eye in good shape and the other still a mess.lol I will be glad when both are done and it is over with. I also have to go see my doctor about my carotid arteries. This will be my 3rd check and I am hoping I won't need the test with the dye like the last two times. I am falling apart piece by piece and just hoping I can stay together long enough to take care of my DH.
The day after the FIRST surgery my sight was better than it had been for years. I no longer needed distance glasses. We stopped at a drug store on the way home from the follow-up visit and I got myself a pair of cheaters for reading. I was legal for driving at that point, but didn't drive until after the second surgery. He was still driving then and I was seeing double at a distance. That got better over the next couple of weeks and I did drive locally at that point.
I did the second eye 3 weeks later. Distance vision got up to the totally normal stage and I was able to drive the day after surgery. The cheaters I had bought were too strong. I did without for a week or two and then went out and got very light cheaters just for reading.
My DH isn't supposed to be driving.... more so because he had had a silent stroke which was found when he had an MRI. I don't particularly want him to drive but he may have to once I have had the surgery. I am hoping the surgery will be done close to home and not in the next county then he won't have to drive very far.
When I had my surgury I was told to bring a driver. I couldn't drive for 24 hours. You can see through the eye patch they gave me, but there was so much stuff in that eye, that I couldn't really see on the way home. I knew something was odd when I realized I could actually see the TV set later that day even though I couldn't wear my glasses and one eye was covered with the clear patch. It was a nice "odd". <grin>
Jean, could you find someone else to be your designated driver that day? Family? A neighbor? And you also need to make arrangements for food for supper in advance. You aren't going to be in the mood to cook anything.
Starling, We don't have any family but if needed I can get someone from our church to drive me to and from. My DH is pretty good about food he will have soup and sandwich or even a TV dinner....as long as it doesn't eat him first he eats just about anything. LOL. This appointment on Tuesday is more a consultation if I understood my eye doctor correctly so I don't know when I will get the surgery.
Jean, you can't have it until you've had multiple drops in your eyes for at least a week, so you will know where you are scheduled.
I used a microwavable meal for a couple of days after my surgery. It was surgery, so I needed time to get back to myself.
Oh, and I haven't mentioned the one thing I NEEDED to know in advance. You can't see them doing the surgery. If it is cataract surgery all you can see is bright lights.
I would have to disagree with your suggestion that cataract surgery be avoided in dementia patients who are mid-stage 5 or worse. My wife is now Stage 5+ and is developing clinically significant cataracts. I am probably going to opt for surgery in the next few months, but she also needs a total-knee replacement. (I think she is a 57 y/o trapped in an eighty y/o body - I really mean that.)
I think the decision needs to be based on:
1. assessment of visual blur and how quickly it may be changing - it's never going to get better. 2. assessment of patient's level of cooperation/combativeness. The family, PCP, and Eye Surgeon all need to be involved. 3. access to someone to help with post-op care. Typically four weeks worth of eye drops.
Once the decision is made NOT to proceed with surgery, you may be sentencing the patient to crummy vision for the rest of their time on earth.
You might be right - but I'd give the LO the benefit of the doubt.
Iggy, I don't have dementia but I do have cataracts. I will have the right eye done on the 19th of this month and my left eye on 3 December. I can hardly wait to get the cataracts taken out and be able to see properly. It must be terrible for someone with AD to have cataracts on top of their other problems I can't imagine how they feel. If your wife needs the surgery and you allow her to have it I pray everything goes well for her and you.
Thanks Jean. Starling might be right for some AD cataract patients. I do place great credence in the saying, often repeated on this board, that when you've seen one case of AD, you've seen exactly one case of AD (they're all different). That's why there has to be communication between the family, the primary-care provider, and the eye surgeon.
I did read an article a few years ago (written by an eye surgeon) stating that there seemed to be less agitation in AD patients after cataract surgery. The thinking was that blurred vision contributed to their agitation. It makes sense. The "normal" patients that I see with clinically significant cataracts almost always are much happier after cataract surgery.
Did your doctor mention anything about bifocal implants? (I'm an optometrist and work in an eye clinic with ophthalmologists. It's always interesting to hear what's going on in different parts of the country.)
I just lost my long post, so here I go again. I hit the wrong button on my keyboard and still can't figure out what I did exactly. <grin>
First, I'd like to point out that when MY HUSBAND was at mid-5 stage, he was HELPING ME deal with the surgeries I was having. If he had needed to have the same surgery at that point I'd have gone with it even knowing what I know now. He was putting the drops in my eyes, so I know he could have handled having them put in his eyes if it had been the other way around.
So I agree with iggy that if you know your LO will cooperate, this is one surgery I'd go ahead with at mid-stage 5 or earlier. I'd make sure that they gave the patient extra anti-anxiety meds. They are prepared to do that. They did it for me. They get a lot of people who are scared to death. You don't have to cooperate DURING the surgery. They fix it so you don't have to do anything on your own while it is going on.
At mid-stage 6 or at 7, I'm not so sure, but I haven't experienced mid-stage 6 yet.
And you do know if your LO will cooperate before the surgery because you have to put multiple drops in the patient's eyes multiple times a day for a week before the surgery. You can deal aggessively with the eye patch if necessary making it impossible for the patient to remove it themselves. I used two pieces of tape each night so I could see through it, but they give you enough tape so you can make it almost impossible to remove yourself.
Hi Iggy, The doctor didn't mention anything about bi-focal implants maybe he doesn't know about them. lol. Actually I was surprised when I saw him. I was expecting someone maybe in their 50's and he looked like a skinny kid! Of course I'm at the age where almost everyone looks like a kid to me.
Starling, I only have to use the drops 2 days before surgery. One drop of 2 kinds 4 times a day. I don't know about after the surgery I assume they will tell me what to do after the op.
Jean that sounds like what I did before. There was a third drug, for me, but since you can't get it at the pharmacy they might give it to you on the day of the surgery. I was on the drops a total of 6 weeks between the two surgeries. I thought I was doing the pre-surgery drops for a week, but it might only have been 2 or 3 days.
I did not get bi-focal implants. My implants were set for distance. But my ability to see got better overall. I use cheap cheaters for reading, and even that is at a very low level, but I do need them.
Reports to the contrary, bi-focal implants are NOT the greatest thing since sliced, white bread. They work well for some, not for others. But once they're in your eye, they're only removed if they're bothering you to the point of causing clinical insanity (not quite, but almost).
Gee Iggy, I'm glad you let us know about the clinical insanity before I asked my doctor about them.LOL. I imagine most of us caregivers can find plenty of things to drive us insane if we let them.