Neurocognitive and Neurodevelopmental Disorders
When dementia or other central nervous system impairment interferes with a patient’s ability to communicate symptoms of cataract, the patient’s functional deficit must be evaluated by other methods, such as discussion with surrogates about the patient’s capacity to carry out activities of daily living. To estimate the visual impairment resulting from the cataract, the surgeon may have to rely on objective findings, such as degradation of the red reflex, slit-lamp abnormalities, and visualization of the retina, rather than subjective measurements of visual acuity. The patient’s ability to tolerate sedation and draping throughout surgery must be appraised, and general anesthesia can be considered for the patient who cannot cooperate. When general anesthesia is required, the surgeon also may consider cataract extraction bilaterally in the same surgical session. In general, the decision to proceed with cataract extraction in complex cases is based on the following aims:
potentially rehabilitating vision
improving visualization of the fundus to monitor and treat retinal disease
enhancing quality of life
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.