Years ago, I was looking after the grandfather of a younger colleague. His grandfather had chosen geriatrics as a specialty 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 been 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 ophthalmologist 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 would tolerate the surgery that eventually occurred without problems, and as a result 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 of the Home for the Aged, who had the reputation of being a “shrier” (someone who spent a good deal of time yelling). It wasn’t clear to the nurses or to his family what he was yelling about. It had been attributed to physical discomfort, but a cause could not be found and simple analgesia did not seem to have a salutary effect.

He was found, during a 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.

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 – although limited, the conversations made sense.

I recently heard from one of our ophthalmologists how often conditions are found during routine or followup eye examination appointments for already recognized conditions. Something is often discovered that, when treated, could have a positive effect on vision.

He described a case in which a patient’s eye pressures were noted to be very much higher than in the previous year. The patient had already lost some of the vision to 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 a condition is necessary in order to consider potential treatments.

In the new year, make sure your loved one gets a proper eye examination so  that everything that can be done to correct eye problems is done. It is a wonderful gift with the apple and honey.