Glaucoma at 91 and she refuses eye drops. Dr. proposes surgery, but I don't see her cooperating. What should I do?

Mimsy1: She most likely has wet Macular Degeneration and the "blood" that you're referring to is blood vessels leaking into the macula. Treatment for this condition in an attempt to save what vision remains is typically eye injections. Any patient of a retinologist must adhere to the protocol directed by the specialist, including eye drops, else all is in vain. Glaucoma is an equally urgent ocular issue. My mother had 'the worst case of wet Macular Degeneration her retinologist had ever seen,' but she continued to live alone in her own home many states from me. She was managing fine UNTIL her blood pressure plummeted, causing me to move in with her to provide care.

As long as she is assessed by PCP as cognitively appropriate and able to make decisions for herself, then accept her acceptance or rejection of eye drops or any other treatment. At 91, she is most likely sensitive to her diminishing health and independence; let her decide as long as she is safe. Also sometimes if one goes along with a patient's refusal of a treatment, they just may decide to say yes, if they can determine that they are the one in control ... Honor Patient rights and her dignity and self respect; Things may go along smoother than the bumpy ride trying to force treatment.

Practice good self care ( for you)... don't feel guilty and, see your own PCP for updates re your own health.

Hopefully we'll all make it to 91 or beyond !!

My Papa, at 93, had both of these issues. He had shots several times then refused. He had surgery twice. But something else always came up, one issue after another. He went blind. They are both horrible conditions, by the time you hit your 90’s, they have done so much damage that the doctor is just putting out fires. The doctor is just trying to save what sight they can.

But at 91 maybe it just seems overwhelming. Maybe she’s afraid she won’t wake up. Whatever it is, unless she has dementia, she gets to decide, I guess.

I would opt for sedation to get both eye issues done. Dementia causes confusion that alters one's quality of life, adding blindness would make things unbearable.

https://www.mayoclinic.org/diseases-conditions/glaucoma/diagnosis-treatment/drc-20372846

(sounds like laser therapy might be the alternative she needs)

Have you considered cannabis for the pressure, pills, tinctures, many forms. Significant evidence to support it. There are cannabis nurses everywhere, rule vary by state.

Has doctor advised against sedation? Age alone does not prevent sedation. If overall health permits, sedation may be tolerated without terrible after effects.

The more info you have, the easier it will be to make a decision. Get a second opinion with a prognosis of her condition with and without the surgery. Will the improvement be lasting and significant? If the procedure is as MargaretMcKen describes, it sounds intense - would she be willing and able to endure such a procedure? Get answers to all these questions and you can make a informed choice.

My mother had the surgery for glaucoma and for her it stopped the eye drops for one eye but she has to do it for the other eye and my mother is 87yrs old. She goes back in Feb to see if she can stop the other eye drop. She is down from 2 different medications to one and only at night. The pressure builds up and it can have consquences.

Prayers you find the right solution

I’m assuming she is mentally impaired or you wouldn’t have this problem. Blindness will make her more so, and more “distant” psychologically.

Give her a “treat” as you would a small child after eye drops. Create a positive association. Hershey’s kiss, a small cookie, a dum dum lollipop. What brings a smile to her face?

The treat does not have to be food related, but keep it the same every time so thinking of the experience triggers a positive reaction in her.

Examples, gentle hand or foot massage, a TV program or soothing music.

instead of saying “here are your glaucoma-preventing eye drops” call it “gentle refreshing soother.”

She may have grown to like this control “game” of being a bit naughty and refusing. Let her play the same game with something else.

This will hit you on two fronts, the blindness and your caregiving needs will go up, a lot. She’ll be increasingly less capable and you’ll not only get hit by caregiving but by the suffering she’ll go through. Blindness, as near as I can tell, is brutal.

I can’t tell you how many times a day my father will remind me he’s blind when I’m with him. It literally never stops!

I don’t have an answer for you, if she won’t, she won’t, but she needs to.

My Uncle gets shots for his Macular degeneration.

Eye drops are a lifetime thing. If surgery is not going to stop the eye drops not sure if I would put her thru it. If she does not use the eye drops for the glaucoma she will go blind. My GF suffered from headaches.

I’ve had no experience with glaucoma, and it sounds as though this is what the surgery is for. I’d check first whether both eyes are affected by both problems, about the type of macula, and the prognosis for sight. If she will lose her sight in both eyes anyway in a year or so, the surgery might not be worth it, even if it is likely to be successful.

Find out what sort of macula degeneration. The macula is an organ at the back of the eyeball connecting to the brain. Degeneration causes a blank spot in the middle of vision. Aged related degeneration is not treatable yet. A ‘wet macula’ is now treatable, and my husband has one. It’s caused by leaking blood at the back of the eyeball, and it sounds as though this has been diagnosed.

Wet macula treatment is not simple. DH has had an injection through the eyeball every 3 months for 2 years now. The anesthetic drops put in before the injection sting badly, the injection itself is sometimes painful depending on whether the anesthetic worked well, then quite uncomfortable when it wears off. It takes him a couple of days to come better. The treatment is actually working well, and he is only 70. He is delighted with the result and tolerates repeated treatments well, but your aunt may not. It would be a good idea to find out about this before deciding about surgery. Your aunt may want to make the choice herself. Sympathy to you all, it's difficult.

Are you talking about the laser surgery that takes less than 5 minutes and controls pressure (selective laser trabeculoplasty) or something else? I think I would ask about the possibility of using some type of calming medication or twilight sedation if it is SLT because the benefits can be amazing and are long lasting. Loss of vision and hearing accelerate dementia and greatly impact quality of life, and although she is a great age many elders are living beyond their 90's.

Let's not forget that sometimes eye drops can sting, thus someone older or even a child may not fully understand. Thus the refusal to use them.

How about a hospice consultation?

You can't force her.


Sedation would likely be as minimal as possible, due to her age and lack of cooperation. I have MANY friends who've had eye surgery and no one said it was 'horrible'.

At 91, you really have to pick your battles. If she's fighting you on simple eyedrops, there's nothing much else you can do.

Honestly I would not bother having it treated.
At some point there is a choice to make "Burden VS Benefit"
If it would stress her out having a procedure done, don't do it
Any sedation can cause long term problems when it comes to a faster decline. You make the choice that you feel she would make her self or make the one that you think is in her best interest.

Her site will diminish but there is little way to know if she will face blindness before she dies of natural causes. There is little you can do in this instance, and whatever can be done will come through her doctor's suggestions for her case. I am so sorry.