Cataracts: Everything You Were Afraid to Ask

You've just been told you have a cataract. Or maybe your mom has one. Or maybe you're just noticing that your vision isn't quite what it used to be — colors seem duller, headlights at night look like starbursts, and your glasses prescription keeps changing. Whatever brought you here, you're in the right place.

I'm Dr. Parul Khator, a board-certified ophthalmologist and glaucoma specialist practicing in Marietta, Georgia — and I created this podcast because I believe one thing deeply: the more you know, the better you do.

In this very first episode of Demystify the Eye, I'm breaking down everything you need to know about cataracts — in plain English, no medical degree required.

In this episode, I'll cover:

• What a cataract actually is (hint: it's not a film growing over your eye!)
• The telltale symptoms that tell me — and should tell you — that it might be time to see your eye doctor
• What cataract surgery really looks like — and why it's one of the most successful procedures in all of medicine
• What to expect during recovery and how to get the best possible results

Whether you're newly diagnosed, supporting a loved one, or simply curious about your eye health, I want you to walk away from this episode feeling calm, confident, and clear-eyed — pun absolutely intended. 👁️

📬 Have a question or topic you'd love me to cover? I'd love to hear from you! Email me at demystifytheeye1@gmail.com

📱 Follow along on social media: Find me everywhere @demystifytheeye

🌐 Learn more about Dr. Parul Khator, MD: https://www.gaeyepartners.com/metro-atlanta-eye-doctors/parul-khator-md/

⭐ Enjoying the podcast? Please take a moment to rate and review Demystify the Eye on Apple Podcasts — it helps more people find the show and means the world to me!

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Demystify the Eye is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your eye doctor or qualified healthcare provider with any questions you may have regarding your eye health.

Transcript

SPEAKER_01 0:00

Hello, my name is Parl Kator MD. I'm an ophthalmologist in Atlanta, Georgia, specializing in cataract and glaucoma surgeries. After practicing medicine for over a decade, I have learned that the more a patient knows about their disease, the better they do. Patient education is a passion of mine. But like most doctors, I have a lot of patients and not a lot of time to see them. So I created this podcast where I could spend the time I don't have during the day to give you insights into the eyeball and ocular disease. Let's empower you as a patient or a patient support system. Together, let's demystify the eye. Today we are going to be talking about one of the most common eye conditions in the world. Cataracts. I often tell my patients they have cataracts, and this statement is usually followed by a look of horror on their faces. I have to quickly follow up by letting them know that cataracts are not a disease. They are a normal aging process. Every single human gets cataracts starting around the age of 40. If you are 65 and you don't have cataracts, please contact me. I'll write an article about you. We'll become famous. We'll tour the world together. Having cataracts is not a bad thing. It just means you have celebrated enough birthdays to get them. And that is a great thing. Cataracts come from the Latin word cataracta, which means waterfall. Picture for a moment Niagara Falls. Think about the dark blue water at the top of the waterfall and the dark blue water at the bottom. The waterfall itself, however, is white as the water comes crashing down. Thousands of years ago, cataract surgery was not as simple as it is today. So people did not get their cataracts removed, and eventually the cataract grew so large it turned white. Have you ever seen an older dog with cataracts? You can look at them from across the room and see the white inside their pupils. People saw this whitening inside the eye and it reminded them of the white water crashing down from a waterfall, hence the name cataract. Did you know that cataract surgery is the oldest known surgery in the world? We have documented it as early as 500 BC. Of course, back then it looked nothing like it looks today. The development of this surgery over the centuries is one of the most fascinating medical stories, and one I will cover in a later podcast. For now, let's stick with what we know about cataracts in the year 2023. Pathophysiology. This bag sits in the front of the eye, right behind the colored portion of the eye. It is suspended in the middle of our eye by millions of tiny strings known as zonules. The purpose of the lens is to focus light that comes into our eye. If our eyes did not focus light, we would never be able to see anything clearly. It would all be a blur. There are two powerhouse structures in our eyes that focus light. The first is the cornea, which is the clear front portion of the eye, and the second is the lens. Imagine for a moment that you are playing tennis. Your opponent hits the ball to you and you follow it until it reaches your racket. You hit it back and follow the ball again to see where it lands. The ability to see the ball clearly as it goes back and forth is called accommodation. And you can thank your lenses for giving you that gift. The lens will change shape from skinny to fat and back to skinny again. This change in shape is what changes your focus from distance to near. In order to change shape, a lens has to be pretty flexible. When we are born, our lenses are flexible and they are crystal clear. However, as we get older, the crystal clear lens stiffens and turns opaque. Imagine that when you are born, your lens is like a glass of water sitting in the front of your eye. Imagine if someone takes out a quarter of the water and replaces it with milk. Things are not quite as clear, but you can still see pretty well through the glass. Now, imagine taking out half the water and replacing it with milk, then three quarters. Now imagine the whole glass is filled with milk. Light really can't get through the glass of milk, so things are pretty dim. The milk can't focus the water, so things are also pretty blurry. When the cataract becomes stiff, it can no longer change shape, so we lose the ability to change our focus from distance to up close. Symptoms. Now that we know what a cataract is, the symptoms of cataracts become clear. Punintended. Common symptoms include blurry vision. You can't make out the expressions of characters on your favorite TV show. Are they frowning or do they have a small smile? You cannot see road signs on the highway until you are right up on them. It makes driving in unfamiliar areas very difficult. Hard time reading. My four-year-old loves to show me things. Look, mama, she screams as she holds out a drawing she's just finished inches from my face. Lately, I found myself taking her arm and moving it way out until it's arm's length distance from my face. I can't see things as close as I used to because my lens is getting stiff. Dimming of light. Light goes through our pupil and then our lens to get to the back of our eye where it gets processed. A cataract is like a curtain shade. It just doesn't let as much light through. So you will find you need a lot more light to be able to see things. Glare. Isn't it ironic? sings Alanis Morset. Cataracts are certainly ironic because just as you need more light in order to be able to see, you also start to get a lot of glare with bright lights. This is especially bad when you're driving at night. The headlights of oncoming cars or streetlights are so bright and they have a huge starburst around them. Dulling of colors. One of the first types of people who come to see me for cataract surgery are my artists. These folks are so sensitive to shades and nuances of color, and the cataract will change the way we perceive color. This makes sense when you think about light going through a crystal clear lens versus a lens that is yellow, white, or brown. I once saw a woman who was a quality control checker in a textile assembly line. She was nearly fired from her job because she could no longer discern the difference between different shades of blue. And of course, there is the famous story of Monet. Just look at one of his paintings from 1920, such as the Japanese footbridge. Then look at his painting Irises from 1923. Claude Monet had cataract surgery in 1922. His cataracts were quite bad and they had dulled his color perception so much, especially on the cool spectrum. He was no longer able to see blues and greens, so his paintings pre-cataract surgery are filled with oranges and yellows and browns. After his cataract surgery, I imagine he was startled to see this range of the color spectrum he had been missing. So his artwork featured these cooler colors. Diagnosis. We dilate your pupil and then take a look. We grade cataracts on a scale of zero to four, with zero being no clouding of the lens and four being one of those white waterfall cataracts you can see from across the room. We also figure out how many cataracts you have in each eye. I'm sorry, what? I can have more than one. Oh yes, you can have up to ten different kinds of cataracts. The most common kind is called nuclear sclerotic, and this is the one everyone gets from aging. But you can also be born with some types or get some from medications or from trauma. There are three types of cataracts that are the most common. These are divided up by where they are located. The most common is nuclear sclerotic, and this is a clouding of the entire lens from front to back. Some people can also develop an extra clouding on the edges of the lens, and this is called a cortical cataract. If you look at the cataract straight on, you will see strips of white coming from the edge of the lens and moving towards the center. Think about the spokes on a bicycle wheel. Cortical cataracts are notorious for creating glare symptoms. The final most common type of cataract is also the most annoying. It is a clouding of the lens on the very back of the bag and smack, dab in the center of your visual axis. If we look at the lens straight on, it looks like someone took a glob of Vaseline and smudged it right in the center. This is called a posterior subcapsular cataract. It seems to pop up out of nowhere and can grow very fast. I'm talking weeks to months. It tends to affect younger people, and this one can definitely be exacerbated by medications such as steroids. I once had a patient who was a 15-year-old boy. He had leukemia and had beaten it into submission, but had been given lots of high-dose IV steroids to do so. Overwhelmed by his condition, his mom had left him a few years back. His dad was taking care of him full-time. I remember clearly his dad was this stoic guy, very tall and imposing, only saying a few words as he sat in the corner of the room at each visit. After years of treatment, this little boy was finally able to go back to school, but he was struggling. He used to have straight A's, but was now getting C's and D's at best. It turns out his cancer treatment had left him with massive posterior subcapsular cataracts to the point he could barely see the board or his books. I operated on his first eye, and the day after we took his eye patch off in the clinic, he immediately read the 2020 line, and there was total silence in the room. You could see the pure joy and excitement on this little boy's face, but I didn't hear anything from the dad. So I looked over to the corner. This little boy's dad was crying, big, fat tears just rolling down his face. True to form, he did not say a word, but cried for the next 20 minutes straight. It was moving. That little boy had decided, after spending years beating cancer, that he wanted to be a pediatric oncologist himself. I lost track of this beautiful family, but I'd like to think this little boy is now in medical school on the road to being a doctor himself. You might be wondering if I have three different kinds of cataracts, will I need three different cataract surgeries? It's a question I get asked all the time. And thank goodness the answer is no. We can remove all your different types of cataracts at the same time. So after looking at your cataract, you will have a boatload of testing done. Honestly, the exam to remove your cataracts usually takes 10 times longer than the actual cataract surgery. But this testing is critical because unless something goes wrong, you will have cataract surgery exactly once in your lifetime. And the surgery will last you the rest of your life. We are not piercing your ears here, folks. Your eyes deserve the appropriate amount of time to make sure we get the surgery right the first time. Besides looking at the cataracts, one of the most important things we will do is look at the rest of your eye from front to back and top to bottom. This is important for three reasons. The first is that cataract surgery can sometimes exacerbate a pre-existing condition. Let's say you are a diabetic and have not been controlling your sugars well. You may have significant changes from diabetes in the back of your eyes. It is vital we get all of this under control before we remove your cataracts, as the additional stress from the cataract surgery can make the diabetic eye disease even worse. This is also true for other diseases like glaucoma. The second reason is quite important as well. As doctors, we need to give you proper expectations for your cataract surgery. Yes, yes, your neighbor might have woken up the day after with perfect vision. Yes, your golf buddy might be able to see the ball perfectly 20 feet out. But the same may not apply to you if you have something else going on in your eye that will limit your vision. The diabetes we talked about before, or the glaucoma, for example. Remember, we can get you back all the vision you have lost from your cataract, but we cannot get you back vision you have lost from anything else. It is really important we give you proper expectations so you are not disappointed by your results. And the third reason we need to do a thorough eye exam is so we can help you choose the right artificial lens to go back in your eye after we remove your cataract. I'm sorry what? I have options? You sure do. Just like everything else these days, you have lots of options. But not all options might be right for you. We will cover the different types of lens choices in a separate podcast. Surgical preparation. A lot of my patients come in thinking they will have their cataract surgery done that very same day. Yes, technology has come a long way with this surgery, but it is still a surgery. You cannot stroll into a doctor's office and then have a piece of your body surgically removed. Or at least you really shouldn't. No, cataract surgery takes some preparation. One thing we need to do is get medical clearance from your primary care doctor. You get IV sedation, intravenous sedation for cataract surgery, and this sedation can interact with other medical conditions you have or other medications you are on. Sometimes you may need extra blood work or an EKG prior to surgery. The other big thing we need to do is get prior authorization from your insurance company. Cataract surgery is a medically necessary procedure that is covered by your insurance, but that does not mean your insurance company will make it easy on you or me. We first need to submit your examination notes to the insurance company for them to review and approve. It kind of feels like when you're a little kid and you have to go present a case to your mom about why you should be able to spend the night at your friend's house. We also need to tell your insurance company what we are planning on doing so they can give us an estimate of what they will pay and what you will need to pay for the surgery. This depends on deductibles and other factors like whether you have one insurance or two. You yourself need some time between the exam and surgery to process all the information given to you about the surgery and about your lens choices. You will need to start some eye drops a few days before surgery. These include antibiotic and steroid drops to sort of prime your eye for the surgery that's about to come. And you need to stop eating or drinking anything after midnight the night before surgery. Your stomach needs to be empty in order to receive the anesthesia medication. Each surgeon usually has a surgery scheduler who will coordinate all of these things for you. My surgery scheduler is like a quarterback, therapist, investigative journalist, and secretary all rolled into one. I tell my patients she will be your best friend before surgery. The surgery itself. Cataract surgery is almost only ever done to one eye at a time. I've only operated on both eyes at the same time for two of my patients. Both were mentally challenged individuals who are going to have general anesthesia, and we were concerned about the stress of the anesthesia medications and surgery occurring twice for these folks. There are a couple of reasons we do the surgery one eye at a time. The first reason is that we place a patch and a shield over your eye at the end of the surgical case for the first night. We do this to prevent you from blinking or poking your eye, both of which could increase the chances of infection. Imagine having your surgery at 7 a.m. and then having both your eyes patched shut until the next morning at 7 a.m. That's going to be a tough 24 hours to function. The second reason is something called TAS. This stands for toxic anterior segment syndrome. Saying the word TAS to a room full of eye surgeons is like saying the word Voldemort at Hogwarts. It is just too scary. TAS is when a patient gets extraordinarily severe inflammation in their eye following cataract surgery. It usually starts within the first 12 to 24 hours and can cause permanent vision loss. There are lots of possible causes, but they are all related to the instruments or medications we use at the time of the cataract surgery being contaminated or perhaps not thoroughly cleaned. Operating rooms are not run like your local dive diner. Hygiene is queen, and there are rigorous protocols in place to keep the OR experience as safe as possible. So this complication is super rare, but it is still never something you would want to expose both of a patient's eyes to at the same time. The third reason is we want to see how your first eye heals before we work on the second eye. Did you get an infection after your first eye surgery? Did your pressure spike? Did you have a weird bleed inside the eye? If so, pump the brakes. We need to fix these problems first and change something about how we perform the surgery or your after-surgery care to make sure the same stuff does not happen to your second eye. So trust me, you only want cataract surgery done to one eye at a time. We always start with your worst eye first, and then around two weeks later, we do the second eye. We used to wait months and months between the two eyes, but we realized that was torture to our patients. You see, the world is really weird between the two eye surgeries. You lose depth perception and things can seem off balance. Also, imagine if you started with a minus six prescription in both eyes. We take out the cataract in one eye and get rid of the prescription at the same time. Now you have a minus six prescription in one eye and a zero prescription in the other. Yikes! We do not want to do the surgery too far apart, but we also don't want to do it too close together. Remember, we have to see how the first eye heals before we tackle the second. Cataract surgery is an outpatient procedure, meaning you do not spend the night in the hospital. It takes about 10 to 15 minutes to actually perform the surgery, but you should plan on being at the surgery center for three hours. This is because of our favorite friend. Paperwork. You'll need to fill out a lot of it the day of your surgery. You will also need to be seen by the anesthesiologist so the two of you can formulate a game plan for your anesthesia. And you need to get an IV as well as eye drops to prepare you for the surgery. Post cataract surgery. You are usually seen three times after cataract surgery: the day after, the week after, and around one month after. We are checking for different things at each of these visits. We are making sure you don't have an infection and that your wounds are healing well. We are also adjusting your medications. You will have activity restrictions for one week after surgery in each eye. These will include no bending over past the waist, no heavy lifting, no strenuous activity, and no eye rubbing. So the day after cataract surgery is not the time to plant your garden for the summer or start training for your marathon. You can still bend at the knees if you want to grab something off the floor. If your knees are listening to this podcast and laughing, remember you can always sit in a chair and lean over to one side to pick up whatever it is you need to pick up. What is considered heavy? Generally anything over 30 pounds. So a six-week-old grandchild is fine, but a four-year-old toddler is a no-go. And the combined motion of bending over and lifting something heavy is the worst. Imagine leaning down and picking up weights off the floor. I will sometimes have a couple that begins to giggle in the exam room as I'm reviewing activity restrictions. And though I know exactly what they want to ask, I keep quiet so I can see who is the brave soul between them to actually pose the question. Uh, hey doc, what about sex? Is that a strenuous activity? It's a really fair question. Though we are referring more to no swimming, biking, or running, depending on the couple, sex could be pretty strenuous. I let them know sex is okay as long as a person who got cataract surgery is on the bottom on their back. This is usually followed by more giggling, but also relief. Don't ever be too nervous to ask us questions. Remember, we are doctors and have gone through at least eight years of training to not be shocked or scandalized. The wounds that we make to do the cataract surgery are under three millimeters wide, so they heal very fast. Your activity restrictions will probably be in place for one week after surgery. During this week, we will also ask you to tape a shield over your eye while you sleep. This keeps you from bonking your eye on your pillow or with your hand. The patch is usually only necessary for the first night. Summary. Cataract surgery is a really happy surgery. It is definitely something I love to do because I can give a patient back portions of their life they might have been missing. Cataract surgery is actually the second happiest surgery in the United States. Do you know what the happiest surgery is? I'll give you a second to think about it. It's a boob job. Breast augmentation surgery is the only surgery that has non-diminishing returns. Patients are generally happier 10 years after surgery than they even are one year after surgery. I also like to think it's the happiest surgery because only one person goes under the knife, but usually two people get to benefit from it. And on that note, I will leave you until the next episode. See well and be well.

SPEAKER_00 25:53

So that's how I fix people's eyeballs?

SPEAKER_02 25:56

Yes.

SPEAKER_00 25:58

Wow. Where do you think I got that magic pen from?

SPEAKER_02 26:01

I don't know.

SPEAKER_00 26:03

Sounds like a pretty good pen, huh?

SPEAKER_02 26:05

Uh-huh.

SPEAKER_00 26:06

Well, thank you.

SPEAKER_02 26:08

You're welcome.