A resource of the MCB/DDS Partnership Project                    
focusonvisionandvisionloss.org
508-384-5539								   

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Eye Surgery Preparation and Post Op Planning
for Individuals with Intellectual Disability
Question List
Proper preparation for both pre- and post-eye surgery for an individual with intellectual disability is a critical part of successful recovery and involves clear communication among the individual with intellectual disability, all caregivers, the eye surgeon and medical team.  The following lists consolidate all of the questions found in the brochure, “Eye Surgery Preparation and Post Op Planning for Individuals with Intellectual Disability” and can be easily brought along to medical appointments and caregiver meetings when critical pre- and post-operative planning occurs.
•	Questions for the Eye Surgeon: “Big Picture”
•	Questions for the Surgeon Regarding After Surgery
•	Questions to Consider Regarding the Recovery Room
•	Questions to Consider Regarding a Hospital Overnight Stay
•	Questions to Consider About Recovery at Home or Respite Home 
•	Questions to Consider About Eye Protection
•	Questions to Consider About Eye Drops and Ointments
•	Questions to Consider About Long Term Recovery
•	Additional Resources
Questions to Consider About L

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Questions for the Eye Surgeon: “Big Picture”

1.	What problem is the eye surgery addressing?

2.	If the goal is visual improvement, how will the individual’s visual ability change after surgery, and at what rate?  

3.	If the goal is pain alleviation, will relief be immediate or gradual?

4.	What appointments, exams and blood work will be needed before surgery? Will any of these appointments require sedation?

5.	What type of sedation will be used for the eye surgery?

6.	What are the risks of the surgery?

7.	How long is recovery from surgery? Will an overnight at the hospital be needed and if so, for how many days?

8.	What will happen to the individual’s vision and/or eye pain if the surgery does not occur?

9.	For the long term after the surgery, will the individual need to wear prescription eyeglasses or sunglasses?

10.	For the long term after surgery, will eye medications need to be taken either by mouth, by eye drop or eye ointment?

A resource of the MCB/DDS Partnership Project                    
focusonvisionandvisionloss.org
508-384-5539								   page 2

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Questions for the Surgeon Regarding After Surgery

1.	What precautions, if any, will need to be taken to protect the eye immediately after surgery?  

2.	Will a bandage or patch or protective glasses be needed?  If yes, obtain multiple sets of these items to accustom the individual for its use. Should a supervised demonstration be practiced at the eye surgeon’s office?   

3.	If anticipated that the individual will have a difficult time tolerating the eye protection what precautions will need to be taken to assist the individual to prevent self-inflicted injury and/or surgical site disruption? 

4.	What medications will need to be administered during the recovery period? 

5.	Will frequent eye drops or eye ointment be needed daily and for how long?  

6.	If the individual has not regularly received eye drops would the doctor prescribe a saline eye drop trial to accustom the individual to drops in general? 

7.	Will there be any physical limitations during recovery?  

8.	For how long after surgery days, weeks will these limitations need to be in place?  

9.	Will there need to be efforts undertaken to prevent constipation and/or straining during the post-operative period?

10.	Is there any anticipation of pain following the eye surgery? What comfort measures and/or medications are available to help with pain?

11.	Will there be any limitations with bathing or showering following eye surgery?

12.	What are the risks during recovery?

A resource of the MCB/DDS Partnership Project                    
focusonvisionandvisionloss.org
508-384-5539								   page 3

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Questions to Consider Regarding the Recovery Room

1.	In the recovery room will the individual need assistance from familiar caregivers for positioning, and reassurance while coming out of sedation?

2.	Will supportive and protective devices be immediately necessary in the recovery room to maintain eye bandages?

Questions to Consider Regarding a Hospital Overnight Stay

1.	During the hospital stay will the individual need assistance from caregivers around the clock to monitor for positioning, reassurance and effectiveness of any supportive and protective devices? 

2.	Will the hospital be able to supply staff to assist with safety monitoring?

3.	How long will the hospital stay be after surgery?

4.	Are there any items or quiet activities that could be brought to the hospital to make the stay more comfortable for the individual? 

5.	Will activation of the hospital TV and telephone add to the individual’s comfort?

A resource of the MCB/DDS Partnership Project                    
focusonvisionandvisionloss.org
508-384-5539								   page 4

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Questions to Consider for Recovery at Home or Respite 

1.	What is the name of the eye surgeon who will be available or on call for 
     post-operative questions? Post contact numbers where visible for all 
caregivers.

2.	What indications (fever, excessive drainage, bleeding, eye pain) 
necessitate transport to the emergency room? Ask the eye surgeon to write 
the specific indications on paper.

3.	Will training for caregivers be needed about eye care after surgery regarding:       
•	eye protection, its use and cleaning
•	use of protective and supportive devices
•	physical limitations 
If so, who will provide training and monitoring of care?

4.	Is someone needed to oversee and/or administer the medications? If staffing support is needed, exactly who will provide? 

5.	Will the individual need support from familiar caregivers around the clock to monitor for safety and the use of any supportive and protective devices? Monitoring is important for effectiveness, skin integrity and circulation as recommended by medical oversight and/or regulation.

6.	The term “support” should be clearly defined for all who are providing it.  
•	Does it mean within arm’s length or across the room?
•	Does the definition change when the individual is asleep? 
•	Does the definition change when the individual is in a vehicle?

7.	If required, will the individual tolerate staying in bed without being monitored?

8.	Will the individual be able to use the bathroom independently?

9.	How many days will the individual need to remain “quiet” during this stage of recovery?

10.	Are there activities or items that should be provided to make this phase of recovery more comfortable for the individual?

11.	Are there activities or items that should that can’t be used for safety reasons, or due to any required physical limitations during the initial recovery phase?

12.	Is the eye surgeon fully aware of what the individual does at work and/or at the day program with regards to lifting, stacking, etc.  

13.	What is the anticipated time for returning to work or day program?

14.	What is the timeline for visual and/or pain improvement?

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Questions to Consider About Eye Protection 

1.	Will it be possible for the individual to wear the least intrusive protection 
available? For example, some individuals will tolerate wearing clear safety 
glasses, but will not tolerate wearing either the clear plastic or pinhole type metal shield that is taped to the face to cover the eye.

2.	Will a desensitization program prior to surgery help the individual relax and be able to tolerate wearing the eye protection?  

3.	Who will work with the individual through this process and evaluate its effectiveness?

4.	Will an anti-anxiety medication be of benefit, pre operatively and/or post operatively? 

5.	Who will administer/evaluate the medication’s effectiveness and duration of use?

6.	Will a cotton bandage be needed under the shield or protective eyeglasses? How often should this be changed? How long will it need to be worn?  

7.	Is there a point in time during recovery when the individual will be required to wear the shield or protective glasses, without the cotton bandage?

8.	Will the individual be able to see through the eye shield if a bandage is not needed?  If yes, train caregivers not to cover center pinholes with the tape.

9.	If tape is needed with the style of eye protection, does the individual have a latex tape allergy? Should an alternative tape be used? 

10.	How and how often should the eye protection be cleaned?

11.	Will the eye surgeon order supportive and protective devices, such as face shield/ helmet and/or elbow splints?

"Focus"

A resource of the MCB/DDS Partnership Project                    
focusonvisionandvisionloss.org
508-384-5539								   page 6

Questions to Consider About Eye Drops and Eye Ointments

1.	Has there been an assessment to determine if the individual can self-
administer eye medications? If the individual cannot self-administer
eye medications, a written plan should include specific instructions
for medication administration with consideration for the individual’s tolerance.

2.	What physical position is the most comfortable for the individual to receive eye medications?

3.	In addition to the caregiver administering the eye medication, is assistance of others needed during this process? Use of favorite caregivers, visual aids, or enjoyable sounds to distract the person as the eye medication is administered may be helpful.

4.	If more than one type of eye drop/ointment is ordered is there a time interval between administering these medications?

5.	What are the storage requirements for the medication?

6.	What should be done if not all of the drops or ointment have gone into the eye?

Questions to Consider About Long Term Recovery

1.	Will visits to the eye surgeon be more frequent than previously?

2.	Will the individual be more sensitive to light (photophobic), requiring the use
     of sunglasses for use both indoors and outdoors?  

3.	If the individual needs light protection, but does not tolerate the wearing of sunglasses, would use of a hat with a wide brim, an umbrella, or positioning to reduce glare and exposure to bright light be helpful?

4.	What environmental modifications will increase safety and function? 

A resource of the MCB/DDS Partnership Project                    
focusonvisionandvisionloss.org
508-384-5539								   page 7

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Additional Resources

There are several online resources that can offer more information and support.  Please always seek professional medical advice in an emergency. 

Administration of Eye Drops and Eye Ointment
•	American Academy of Ophthalmology
	https://store.aao.org/eyedrop-information-pad.html

•	Prevent Blindness America
	https://www.preventblindness.org/sites/default/files/national/documents/fact_sheets/MK17_EyedropMeds.pdf

•	WebMD
	https://www.webmd.com/eye-health/how-insert-eye-drops?print=true

Standards to Promote Dignity, Supports and Health-Related Protections
•	Massachusetts Department of Developmental Services https://www.mass.gov/eohhs/gov/laws-regs/dds/115-cmr-100-1000.html

•	Massachusetts Department of Developmental Services
	https://www.mass.gov/files/documents/2016/07/st/reg-115cmr005.pdf

“Focus” Resources
For a downloadable copy of this Question List, the full brochure: Eye Surgery Preparation and Post Op Planning for Individuals with Intellectual Disability, and more information regarding the full array of MCB/DDS Partnership Project resources, videos, eye care provider list by town, and events including the annual “Focus” on Vision Impairment and Blindness Conference: Meeting the Needs of Individuals with Intellectual Disability and Vision Loss, please visit the "Focus" website: www.focusonvisionandvisionloss.org

Developed by: 					Contributors:			 
Elizabeth Fitz, MS, RN-CFNP			Jean E. Ramsey, MD MPH		
Lisa DiBonaventura, MA, COMS			Kathleen Kenney, M.Ed., COMS

A resource of the MCB/DDS Partnership Project                    
focusonvisionandvisionloss.org
508-384-5539								   page 8

"Focus"

© October 2018