Question
QUESTION: My mother is 90. I recently became her caretaker and am responsible for taking her to all her doctor appointments. She had a cornea transplant about 18 years ago and it created more problems than it resolved. Her vision in the left eye has deteriorated over the years since the transplant. Now her vision is almost completely gone in that eye (left eye). She can see only a little light and a little motion with the left eye. The doctor has prescribed the following eyedrops for pressure in her left eye. COSOPT 2X/DAY, ALPHAGEN 2X/DAY, LUMIGAN 1X/DAY @ Night. She does TRAVATAN 1X/DAY @ morning in her right eye. She has been taking these meds for at least a year. On her last doctor visit in October, the doctor said her pressure in her left eye was 21 (17 using a mechanical tonopin?). On her previous doctor visit in August, her pressure in the left eye was 13. (The right eye pressure is always 9 or 10).
The left eye very often looks like it is red and painful. The left eye looks like it is sinking back into her head and the left eyelid is starting not to close completely when she is sleeping.
The right eye looks beautiful and healthy.
The eye doctor says to keep doing what we have been doing.
I don't think there is any chance for her vision to return in the left eye.
Do you think there is any way to help my mother even if only to help her eye feel more comfortable?
Do you think the meds are appropriate?
I will relly appreciate your help and advice.
Thank you
IMAGE: My MOM
ANSWER: Your question is very hard to answer without actually examining your mother (although the picture did help - thanks!) Additionally, it involves mainly ophthalmological issues (regarding surgery) so is a little bit outside my area of expertise. Nonetheless, I will do my best to answer.
There is very little likelihood your mother will ever regain vision in the left eye. If it has been 18 years since the transplant, we have to consider the possibility that she is rejecting the graft. Just like any other foreign tissue, there is always a chance the body will reject the transplant after a period of time. Now we get into the part I cannot answer. I do not know what the standard of care would be for a 90-year old with a graft rejection. If the eye is chronically uncomfortable AND the vision loss is from some retinal problem like macular degeneration - as opposed to the cornea being cloudy from a rejected graft, it might be better just to remove the eye. (I know that may be shocking to you, but with a 90-year old, our options are more limited than in a young person.) And if the vision loss IS from a cloudy corneal graft, I still very much doubt they would re-implant a 90-year old, so you may have a dilemma on your hands.
Next time your mom sees her eye doctor, I would try to pin him down as to two things:
1) Why is the vision so poor? (cornea versus retina, or something else)
2) Why is the eye chronically red and painful? (and what can be done about it?)
From there you can begin to discuss what options you have to relieve the discomfort, given that the vision will most likely not be restored in any case.
---------- FOLLOW-UP ----------
QUESTION: Dr. Margaret, thanks for your quick reply.
If it was decided the best thing would be to remove the eye, is that procedure safe for a 90 yr old?
How do they remove the eye? Do they replace it with something or just leave a void space there?
Are there any issues surrounding the removal procedure or the after care?
Being such a sensitive and personal issue, normally how might a 90 yr old
react to such an idea?
Thank you,
Joe
Answer
Well, let's not jump to conclusions about this unless and until your eye doctor says it is your only option for relieving her discomfort. But I believe the eye could be removed (remember I am not a surgeon) without much risk to your mother's health. An artificial eye can be made for strictly cosmetic reasons if you feel this is important, but an artificial eye must be removed and cleaned periodically, so you may want to consider whether it is worth it as you would either have to do this for her, or take her to someone who can. As for how a 90 year old might react, I suppose that could vary greatly, depending upon how rational your mother is at this point. Can you explain the reason to her and is she cognizant enough to understand? If not, I very much doubt you can do this because the emotional strain might be more than she can bear if she does not understand.
){kind=link}