Choose between cataract surgery + possible covid exposure at hospital
June 29, 2020 4:58 PM   Subscribe

Family member who is 70+ and considered high-risk for Covid because of diabetes and recent history of cardiac disease, now needs cataract surgery. The doctor didn't say now-now. Help me weigh the risk involved in a possible exposure at the hospital/follow up appointments and via any complications that might occur.

Related medical background of family member: Age 70+ and these issues: diabetes, blood pressure and high cholesterol. Medications are being taken regularly and under control. They had/have cardiovascular disease that needed two angioplasties a year ago. Because we consider them high risk, we lead a very restricted life at home to minimize any covid-exposure. All essentials are bought via deliveries or store-side pickups. We do not socialize with any other family/friends or neighbors in their homes or ours. Only social interaction is with 1 other family at our or their front yard/driveway. We only leave home for joy rides in the car for 1 to 1.5 hours at the maximum.

Our first exposure to another person indoors (since stay-at-home guidelines begain in mid-March in our US city) was at the eye clinic today to get a blurry eyesight issue seen by a doctor. And we have learnt that they have cataract developing in eyes. One needs surgery but the other eye is quite mild. My family member is able to do almost all daily activities with some inconvenience - reading, laptop, gardening and many other home chores. They are not able to articulate how much inconvenience. But when they try to see with one eye at a time, the difference is significant. (So my guess is that 1 eye is compensating for the other quite a bit which is why they have gotten by for quite a while). They did say they started becoming aware of the blurriness - about 2 weeks ago. To note is that this family member has a high tolerance-level so they may have been putting up with this for much longer.

I wanted a quantitative explanation of how bad the cataract is from the doctor and they said: 20/200 vision in the eye that needs to operated first. How bad or difficult does this make day-to-day life? (I don't know). They also wear prescription glasses for short sight and long sight but of course that's not fixing the blurry vision problem in one eye.

What questions should I be asking to figure out how bad the cataract is (from doctor and from family member)? Should I have been given a written report at the end of such an appointment? The doctor specializes in cataract surgery among other eye ailments.

In my mind: A trip to the hospital for surgery means contact with at least a dozen people all of whose health situations we are not aware of. Even if they are all in good-faith asymptomatic and wearing masks, we *do* know that masks and whatever possible social distancing (that is possible in a hospital) - does increase covid exposure risk to a much higher level than what we are currently allowing for.

What does it mean for a cataract surgery to be delayed by 3 months (I don't see things going to be in much better state), 6 months (hopeful) or 1 year (hopeful of a vaccine for at least high-risk folks)?

Is the loss in quality of life due to possibly inconvenient vision for the next 1 year going to be worth the risk of covid-exposure to a high-risk individual? Can a cataract considerably accelerate in 3 months/6 months/1 year that the procedure after this period will affect the effectiveness of surgery?

Thanks a lot for any answers you might have to above questions. Or any links to great resources on understanding everything behind cataract surgery.
posted by alady to Health & Fitness (16 answers total) 1 user marked this as a favorite
2/200 vision in the eye that needs to operated first. How bad or difficult does this make day-to-day life?

I don’t really know anything about cataracts, but 20/200 is basically legally blind - per the SSA, “We consider you to be blind if your vision can’t be corrected to better than 20/200 in your better eye.” Source (PDF)
posted by insectosaurus at 5:09 PM on June 29

Thank you for your reply @insectosaurus. That was a typo. The doctor had said 20/200 and not 2/200. Let me try and edit my post.
posted by alady at 5:12 PM on June 29

posted by LobsterMitten (staff) at 5:14 PM on June 29

This seems like a question you should ask the eye surgeon. AFAIK, cataracts are never life-threatening or even truly urgent, and so delay is really only a matter of convenience and comfort. I've never heard of there being any extreme urgency to remove a cataract because something awful could happen if it was left there. Instead, it's largely a matter of when the hassle of life with the cataracts outweighs the hassle of having them removed. But something to keep in mind is that having cataracts removed is not without risk of complications. I, a 65 year old with some underlying conditions (mainly hypertension and only one kidney), had both cataracts removed late last year and just had a detached retina, which is a fairly common side-effect. The repair required several visits to the retina specialist even though it went very well. It seems to me that the decision about when to do the cataract surgery should be up to your family member once he/she has all the relevant information. In other words, it's really a judgment call but I would strongly recommend considering the input of the eye surgeon.
posted by DrGail at 5:19 PM on June 29 [2 favorites]

My mom was supposed to have cataract surgery but then had a heart attack and didn’t get her cataracts done for...three years at least. It’s generally not something that’s urgent, although her vision was much better after.

I also don’t think cataract surgery is usually done in a hospital? It was an outpatient procedure at the eye clinic.
posted by Violet Hour at 5:20 PM on June 29

If it's really one eye that is the main problem, I wouldn't think this is an issue worth risking COVID-19 over. I have friends and family members who have lost an eye entirely, and their quality of life is fine. The other eye compensates a lot. They basically just can't play sports much anymore, and driving is riskier (but still permitted). It doesn't sound like those are issues for your relative.

I also had grandparents who had cataract surgeries and I don't recall it being an emergency/urgent surgery. Like, I think waiting, even though the cataracts got worse in the meanwhile, did not negatively affect the final outcome after later surgery. But you can and should ask the doctor about that.
posted by lollusc at 5:20 PM on June 29

I had this conversation with my mom, too, and made her get firm answers. We're waiting, she's able to drive, this is non-emergent as long as the driving isn't creating other potential emergencies. Eventually vision will get bad enough that daily life functions will be affected, but it's not an abrupt process, and them getting a bit worse doesn't make the surgery any different.

The eye doctor would of course LOVE for her to do it so he can bill, but when cornered agreed that no, waiting 3-6 months (silly me, I thought that's all we'd need) was fine and it was mostly a visual-safety issue not a surgical complexity issue.
posted by Lyn Never at 5:25 PM on June 29

If your family member has a serious hearing loss, or is likely based on family history to get to the point of having a serious hearing loss, consider that being unable to see will present far greater communications difficulties for them than a hearing person.

Many older adults have diagnosed hearing loss. If your relative seems to have more trouble hearing you when they aren't looking at you, I would lean strongly towards considering cataract surgery.

A trip to the hospital for surgery

This isn't the only option. There are standalone eye surgery centers. Check on what your options are, then you can see what precautions the surgery center is taking.

Is the loss in quality of life due to possibly inconvenient vision for the next 1 year going to be worth the risk of covid-exposure to a high-risk individual?

I'm assuming you are asking here first to inform your conversation with them about the risks and benefits. You'll also want to find out how the healing period generally goes for cataract surgery and what the general risks are of that procedure.
posted by yohko at 5:29 PM on June 29 [2 favorites]

One other thing to consider is the possibility that further shutdowns might impact non-essential surgeries and either make them unavailable or increase wait times. If you are in the US, consider that the federal approach to the pandemic has the potential to change rapidly in the next 7 months.
posted by yohko at 5:32 PM on June 29 [4 favorites]

What does your relative think? At some point it's a matter of quality life. Is it worth it to risk covid because eye sight is so important? How safe is the hospital and how safe can your relative be during their recovery?
posted by violetish at 5:35 PM on June 29 [1 favorite]

Seconding yohko about specialized eye surgery places being a safer option and a LOT of this depends on where you are. If you lived near me, we have a hospital that hasn't seen a COVID patient and is pretty safe right now, or in Massachusetts where their transmission rate is super low. THAT said, my partner had a fast-growing cataract (as a 40s-ish guy, this is a thing that can happen) and while it was annoying it was mostly not unworkable as long as the other eye was fine. If this is a slow-growing cataract, they can probably wait a fairly long time. It's also worth knowing that some places are kind of pushing to get more elective surgeries done so having some Real Talk with them about options for your relative may need to happen against a slight pressure for that reason.
posted by jessamyn at 5:54 PM on June 29

I wouldn't know how to answer this question without knowing more about the locality where you are. In the US, some states (including mine) have now paused "elective" surgeries again, due to the very high risk in those areas. If you aren't in the US, it really depends strongly on the situation in your country (well controlled with small, quickly found outbreaks? Or, widespread community spread?)

The risk also will depend on the specific health system you'd be involved with, as a few other commenters mentioned. It's a good idea to ask for information about the precautions being taken by any hospital/surgery center involved, including if they regularly test staff and support them when they can't come to work (so they're incentivized to be up front about any symptoms).
posted by nat at 5:56 PM on June 29 [1 favorite]

My mother (85) had cataract surgery last August after waiting about five years. She had an increased risk due to some issues with the other eye - basically left it as long as she could handle it.

We went into the day surgery place in the morning, and were home by lunch. She was walking the dog (in heavy sunglasses) that afternoon. So, unless there are high health risk factors, it probably won't be in the hospital -- which is good, as C-19 patients won't have been in the day surgery facilities. Did the surgeon say explicitly that it would be in hospital?

Risk factors to consider:
- where do you live? What is the infection rate like? (I'm in Maine; we have 15 - 40 new cases per day statewide, and something under 100 total in the county where my mother lives. In that situation I would not hesitate for her to have a medical procedure done.)
- what is the exact facility where this will be done?
- How much is the cataract impacting the patient's quality of life? Many people (my mother included) delay cataract surgery for YEARS for a variety of reasons. If the patient has good sight in the other eye, or, frankly if they're just unwilling or afraid to do the surgery, then putting it off can be a reasonable option.
posted by anastasiav at 8:24 PM on June 29

I can't really talk about cataracts, but FWIW, I was in the hospital (NW WA state) on June 10th for an elective surgery, and I was very impressed with all the measures that were being taken. I think perhaps there may have been a catching-up period as institutions were waking up to the reality of just how crazy Coronavirus is, but we're well past that now, and at least at our hospital, they are definitely going above and beyond.
•Well-organized queue just to enter the building. 6ft separation, screening & temp check just to enter the facility. Sticker on your shirt showing you've been screened.
•Re-organized interior. Less furniture and surfaces, less clutter, wider traffic paths.
•They disinfected EVERYTHING just prior to me using it. Okay, we need you to change out of your clothes and into a gown, they're disinfecting the changing room now... Like, the patient ahead of me had JUST walked out in her gown, and they had someone going through it spraying and wiping everything down, before I used it.
•I noticed that everything they used, the little pulse oximeter, stethoscope, blood pressure gadget, they wiped everything down just prior to using it on me, and just after, too.
•Everyone in masks, everywhere
•In the surgery prep room, they were only using every alternate bed, for distance

I was scheduled to have this taken care of back in February, but they kept pushing me back and pushing me back until they thought it was safe to allow elective procedures like mine. I feel like if your facility is willing to take patients for elective procedures, they've probably got it figured out.
posted by xedrik at 6:57 AM on June 30 [1 favorite]

If this is going to happen the U.S., most cataract surgeries take place at a center dedicated to eye surgery not a general hospital.

When I had cataract surgery last summer it was at such a facility.

I think I was in a waiting room for about 10 minutes with one other person (they were at least 20 feet away) and then was taken back where I received some pre-op meds administered by one nurse who then took me into a room where a laser obliterated the cloudy lens of my eye.

I was then taken to the operating area where the new lens was slipped into an incision on the side of my cornea that had been made by the laser. There were two nurses and a doctor in the room with me during this time.

I then was taken to a recovery room by one of the same nurses and within 10 minutes, met with the doctor who told me everything went well and he released me to go home.

I was at the surgery center for about 2 hours total time.

Rinse and repeat one week later for the other eye.

I was exposed to 5 other people during the time at the center - The other person in the waiting room, the doctor, two nurses and the receptionist.

By the way, they were amazed when I returned for the second surgery and could recount exactly what happened durig the first. Apparently the anesthesia is supposed to obliterate the memory of the event, but for whatever reason, I recall everything about the two surgeries.
posted by mygoditsbob at 6:13 AM on July 1

Correction to my previous comment

Many older adults have diagnosed hearing loss.

While technically true, this should have said "Many older adults have undiagnosed hearing loss"
posted by yohko at 4:34 PM on July 2

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