This is the 7th and final episode of this GENEYE POD series on getting started with presbyopia correction at the time of cataract surgery.

Residual ametropia is one of the most common reasons for patient dissatisfaction after presbyopia correction at the time of cataract surgery, so it’s really important to look for this and treat it whenever necessary. With a few exceptions, presbyopia correcting IOLs, whether bifocal, trifocal or EDOF are more sensitive to residual refractive error than monofocal IOLs. Failure to hit refractive target might result from inaccuracies in biometry, inadequate selection of IOL power, limitations of the formulae that we have, or inability to adequately predict effective IOL position in the eye amongst other reasons. Laser enhancement, usually by either LASIK or PRK has been shown to be efficient, effective, predictable and safe, and would be the most common choice for refractive adjustment post-operatively. IOL rotation or exchange is required less frequently.

As presbyopia correction, particularly with trifocal IOLs continues to gain popularity across Australia, New Zealand and many other countries, residual refractive error has been identified as a real problem. Surgeons now need to be aware of the importance of residual refractive errors and solutions for corrections need to be considered at the time of starting out with these lenses. Presbyopia correcting IOLs are not as forgiving as monofocals. Residual refractive errors not only blur vision but enhance dysphotopsias and other side effects. Residual refractive errors can be regarded as “make or break” in terms of success for each individual patient, so it’s very important to have a strategy for correction when they occur.

In this episode, Dr Jacqueline Beltz is joined by Dr Laurence Sullivan. Laurie is a cornea, cataract and laser refractive surgeon in Melbourne, Australia. Laurie only recently retired from his public appointment at the Royal Victorian Eye and Ear Hospital where he worked for many years. At the Eye and Ear, Laurie was integral to the training and education of registrars and fellows including Jacqui.

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This is episode 6 of our 7-part series on getting started with presbyopia correction at the time of cataract surgery. So far, we’ve discussed options for correcting presbyopia, patient selection and optimisation, astigmatism correction, assessing corneal tomography and patient conversations and consent. So, now we are finally up to the surgery.

In this episode, Dr Jacqueline Beltz and Dr Andrea Ang discuss optimising surgical techniques for presbyopia correction as well as managing complications. Even though these cases are often not the most complex cataract surgeries that we do, of course, complications will still occur, and it can be difficult when a patient is expecting presbyopia correction.

Andrea is a cornea, cataract and refractive surgeon in Perth, WA where she is also Director of Training for RANZCO WA. Andrea graduated with the gold medal in medicine from UWA and also has a Masters in Public Health from Harvard. Andrea is double fellowship-trained in Cornea – she did this training at Cincinnati Eye Institute and Singapore National Eye Centre, giving her a really broad and interesting experience.

Please subscribe to this podcast and remember that the full digital course is available at geneye.org.au

This is episode 5 of this 7-part series on getting started with presbyopia correction at the start of cataract surgery. This series forms part of a virtual and real-life training package on the same topic. The intended learners are advanced ophthalmology trainees in Victoria, but at least some of this information will be relevant to anybody involved with cataract surgery in some way. The entire package is accessible on geneye.org.au.

So far, we have covered available options for presbyopia correction, patient selection and optimisation, astigmatism correction, and corneal assessment. In this episode, Dr Jacqueline Beltz and Professor Michael Lawless sit down to discuss patient conversations.

Patient conversations might even be the most important part of presbyopia correction. It’s so important for a patient to be well informed so that they can make a smart decision based on their own priorities and circumstances as to what sort of IOL they might wish to receive. There is no one size fits all model, and every option has its own pros and cons.

Professor Michael Lawless is a cataract, cornea and refractive surgeon in Sydney. Mike is double fellowship trained in Cornea and truly one of the greats when it comes to not only achieving excellent results for his patients but in providing them with the information that they require to make a sensible decision. He also happens to be really great at helping the rest of us to do the same.

Please subscribe to this podcast and remember that the full digital course is available at geneye.org.au