MGordon_MD
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Sep 24, 2008, 12:00 PM
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By Dr. Michael Gordon
Years ago I was looking after grandfather of a younger colleague who had chosen Geriatrics early on in its development in Canada. I had previously seen his grandfather who was in his 90s for medical problems all of which had resolved. Now the reason for the consultation was different- he was nearing his 100th birthday and had requested a different ophthalmologist for his birthday gift. The one he had seen for the previous five years had discounted the potential benefits of exposing him to cataract extraction with, “After all you are ~95, or 96, or 98. Is this really what you want at this age?” Now as his children asked him what he would like for his 100th birthday, he said, “A new ophthalmologist”. They complied and that ophthalmologist asked me whether he was “fit” for a local anesthetic cataract extraction.
It was clear from my examination that he could tolerate the surgery which eventually occurred without problems and he had useful and meaningful vision until he died some years later. The case was not my first in which a frail elder was able to benefit from a cataract extraction under circumstances that had not been initially considered. Early on in my career, not long after an ophthalmologist with whom I had done residency training years before came on staff as a consultant at Baycrest. He asked about a resident in the Home for the Aged who had the reputation of being a “shrier” (someone who spent a good deal of time yelling out). It was never clear to the nurses or to his family what he was yelling about, and sometimes it had been attributed perhaps to physical discomfort but a cause could not be found and simple analgesia did not seem to have a salutary effect.
He was found on his routine eye examination to have significant cataracts. Initially the family was reluctant to consider the surgery as their father had some degree of dementia and they were worried about possible deleterious effects. After the ophthalmologist explained that the surgery could be done under local anesthetic and I could find no medical reason to reject the possibility – he had the procedure- and like magic, within a few days of his patch coming off his eye - he stopped yelling and started to interact meaningfully with those around him - cognitively impaired he was – but he was no longer visually disconnected from the world. He loved to sit by the elevators and watch people getting on and off and he had a kibbitz with them – limited but it all made sense.
I recently heard from one of our ophthalmologists how often conditions are found during routine or follow-up eye examination appointments for already recognized conditions, that something is discovered which when treated could have a positive effect on vision. He described a case in which the eye pressures were noted to be very much higher than previously noted more than a year before. The patient had already lost some of the vision to the diagnosed glaucoma. Proper treatment restored some of the borderline impaired vision and would likely prevent further visual deterioration. Whether it is one of the common conditions of the elderly, cataracts, glaucoma or macular degeneration, or something less common, recognizing the condition is necessary in order to consider potential treatments.
In the New Year make sure your loved one gets a proper eye examination to make sure that everything that can be done to correct eye problems is done. It is a wonderful gift with the apple and honey.
This article was originally published in the Canadian Jewish News.
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Dr. Michael Gordon is Medical Program Director, Palliative Care Baycrest Geriatric Health Care System in Toronto, Canada and Professor of Medicine, at the University of Toronto. He is co-author with Bart Mindszenthy of Parenting Your Parents.
Parenting Your Parents is available in bookstores and online at: Indigo-Chapters, Amazon and Barnes & Noble. It is available in a US edition: Parenting Your Parents: Support Strategies for Meeting the Challenge of Aging in America.
For bulk orders email info@dundurn.com. Call: 416-214-5544 or Fax: 416-214-5556
Dr. Gordon is the author of the engaging memoir Brooklyn Beginnings: A Geriatrician's Odyssey, published by I-Universe.
Brooklyn Beginnings is available in bookstores and online at: Indigo-Chapters, Amazon.ca, Amazon.com, Barnes and Noble and I-Universe
Visit Dr. Michael Gordon's website.
(This post was edited by MGordon_MD on Sep 24, 2008, 12:53 PM)
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