The 'age' game

September 17, 2019

When considering surgey, does a patient's age really matter?

The term ‘ageism’ was coined in 1969 by Robert Neil Butler to describe prejudicial attitudes toward older people, old age, and the aging process.

Many years ago, an ophthalmologist in the neighboring city of Pasadena referred a patient to see me in Los Angeles. He noted that she was in need of a corneal transplant for a scarred right cornea.

The patient, Helen, was a very proper well-spoken and intelligent lady with dense amblyopia in her left eye, to the point that she had been functionally one-eyed her entire life. A glance at her birthdate revealed that life to have been 100 years long!

I explained to Helen that a corneal transplant required a lot of postoperative medications and visits. Was it really going to be worth it to her to go through all that at her age?

“What is the main thing that bothers you about your vision now?” I asked her.

“It’s difficult to make out stock prices in the newspaper,” Helen replied. “I have trouble telling if the price of a stock is 11 and 3/8ths, 11 and 5/8ths or 11 and 7/8ths.”

I laughed because I assumed she was kidding with me. However, Helen was completely serious, and she didn’t laugh.

“Do you buy and sell a lot of stocks?” I asked with a smile.

“Yes. Every day,” Helen replied, once again with a straight face.

I was not sure whether it would be a wise move to put a 100-year-old woman through such a surgery, even though she appeared to be completely healthy. Thinking for a moment, I asked her to return with her son so that we could discuss the procedure and recovery in greater detail.

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Making a decision

It turned out that her son was 75 years old, though he looked to be about 45, and, I learned, was the busiest orthopedic surgeon in the hospital where he worked. It was clear to me that the genes in this family were something special.

“Your mother is 100,” I said. “Are you comfortable with her having a corneal transplant?”

“Of course. Why not?” he replied.

The surgery went well and Helen had very little postoperative astigmatism. She had no trouble using her eye drops and coming in for postoperative visits as instructed.

Within a few weeks, her vision had improved to 20/40 and she and her son were happy.

And here’s the thing that really impressed me: On every single visit for years after her surgery when I would walk into the examination room, Helen would be hard at work with her newspaper open carefully circling the prices of her stocks and managing her portfolio. To this day, I think of Helen whenever someone tells me that a patient should or should not have something done because of his or her age.

Disclosures:

Peter J. McDonnell, MD
E: pmcdonn1@jhmi.edu; P: 443/287-1511
Dr. McDonnell is the director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.