This is the third episode of a 7-part series on presbyopia correction at the time of cataract surgery. This podcast series forms part of a GENEYE digital course that has been developed by Dr Jacqueline Beltz for Advanced Ophthalmology Trainees in Victoria, Australia. The full course is available at geneye.org.au under online training.

Astigmatism management is one of the hottest topics in cataract surgery today. It’s essential if we are to aim for excellent results and happy patients. Uncorrected astigmatism leaves patients with blurry vision and resultant decrease in contrast sensitivity. In Australia, we are fortunate to have amazing access to astigmatism correcting IOLs, with it being common for surgeons to implant toric IOLs in up to 80% of cataract patients.

Unfortunately, astigmatism management in the public setting lags behind what we can access for our patients in private. Whilst there is some state-to-state variation, in Victoria at least we do not generally have access to low power torics for our patients. This leads to many more patients in the public setting being spectacle dependent for all distances post-cataract surgery than would be expected in private. There’s a massive gap in the provision of care here and I know at least at my institution a lot of work is being done to improve access of toric IOLs for these patients.

Meanwhile, this gap in patient care translates to a gap in training and experience of our next generation of ophthalmologists. With the reduced emphasis on refractive outcomes resulting from many patients needing glasses for clear vision anyway, trainees are not getting adequate exposure or education in refractive cataract surgery.

Astigmatism management when utilising presbyopia correcting IOLs is non-negotiable. It’s absolutely essential to treat as much astigmatism as possible as any residual will not only degrade image quality but also further exacerbate side effects such as glare and haloes.

Dr Ben La Hood is an Ophthalmologist from New Zealand and now practicing in Adelaide. Ben has worked really hard to develop his knowledge and skill in terms of understanding astigmatism, correcting it and most importantly helping others to also succeed. Ben hosts two podcasts of his own - Ophthalmology Against the Rule in which he talks about surgical topics with his colleague Dr Nick Green, and The Second Look that features interviews with some leaders in our field. In episode 3, Ben and Jacqui discuss some of the critical features in relation to astigmatism correction at the time of Presbyopia correction.

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