S02E07: Refractive Enhancements - Presbyopia Correction at the Time of Cataract Surgery

GENEYE POD

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.

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