The most pressing issues affecting Australian ophthalmology have been laid bare in the new Podthalmology podcast, hosted by Melbourne eye doctor DR LANA DEL PORTO. She discusses the philosophy behind the series, which includes guest appearances from leading cataract and refractive surgeons.
Have you considered auditing your cataract surgery performance, but struggled with getting started? And how deeply have you thought about the unconscious gender bias within your clinics, or whether increased uptake of presbyopia-correcting intraocular lenses (PC IOLs) is being driven by new technology or patient demand?
These thought-provoking topics – plus several more – are among the first episodes in a new podcast series called ‘Podthalmology’, hosted by Melbourne ophthalmologist Dr Lana Del Porto.
Dr Lana Del Porto.
The podcast, released on 30 August, is sponsored by Alcon and produced by Bench To Bedside – an organisation focused on podcasts for Australian medical specialists dedicated to areas such as ophthalmology, oncology, haematology and rheumatology.
Podthalmology comprises five episodes where Del Porto delves into various industry hot topics with prominent Australian cataract and refractive surgeons. With three of the five guests being female, it has been endorsed with the RANZCO Women in Ophthalmology ‘tick’, achieving at least 35% female representation.
Del Porto is an accomplished ophthalmologist in her own right. Her training has taken her to the prestigious Moorfields Eye Hospital in London where she completed fellowships in neuro-ophthalmology and strabismus. Today, she is an associate at three private practices in Melbourne while heading up the neuro-ophthalmology unit at The Royal Victorian Eye and Ear Hospital (Eye and Ear) where she also teaches cataract and squint surgery.
She has an active social media presence (Instagram: @drlanasurgeon) where she regularly posts ophthalmology-related content to raise the profile of the profession, which she believes is part of the reason she was approached to host Podthalmology.
“When I looked at the topics to be discussed in each of the five episodes, I was excited, thinking there’s certainly some controversy here and thought-provoking topics that would be of interest to our industry,” she says.
“In particular, there’s an episode about women in ophthalmology that focuses on unconscious gender bias, which was really interesting. There’s also an episode on presbyopia-correcting IOLs, which are the way of the future. I use them in 80-90% of my cataract patients. These subjects among others, are topical to our industry and many ophthalmologists want to hear about them.”
The five episodes include:
• Audits in ophthalmology – Dr Ben Connell, principal associate at Eye Surgery Associates in Melbourne.
• Patients and referrers – what they really want and why does it matter? – Dr Armand Borovik, staff specialist at Prince of Wales Hospital, Sydney.
• Unconscious bias in medicine with a focus on ophthalmology – Dr Tanya Trinh, Sydney ophthalmologist and presenter of ‘Unconscious Gender Bias and How it Contributes to Imposter Phenomenon in Women’.
• Is new IOL technology driving broader use of PC IOLs or is a patient-centred approach to measuring outcomes making PC IOL use the new normal? – Associate Professor Smita Agarwal, Clinical Associate Professor at the Graduate School of Medicine, University of Wollongong.
• Training: Next generation eye surgeons – Dr Jacqueline Beltz, staff specialist on the corneal unit at The Royal Victorian Eye and Ear Hospital.
For time-poor ophthalmologists, keeping on top of industry-specific developments can be tough, so Del Porto expects the podcast to resonate with her colleagues whether they be commuting, at the gym or in the garden.
Podthalmology’s arrival also comes amid a golden period for local podcasting, with 40% of the Australian population over 12-years-old now tuning in monthly for podcast content, significantly higher than pre-pandemic levels (22% in 2019), according to the latest Infinite Dial Australia report from Edison Research, commissioned by Commercial Radio Australia.
“Podthalmology is a great opportunity for Australian ophthalmologists to listen to familiar voices talking about concepts within the field they might not have given much thought to, which may improve their practice,” Del Porto adds, noting her own learnings from the experience professionally and in terms of digital audio production.
“It’s been a fascinating process. Each episode required background research to ensure I could engage with each of the guests on their topic of expertise. We provided the questions in advance and I tried to make the topics juicy for the audience, but I found that it’s also important to let the guest lead the discussion and for me to tailor my responses accordingly.”
The first Podthalmology episode (20min 33sec) was released on 30 August on the Bench To Bedside website – which requires listeners to provide their Ahpra registration number – where Del Porto interviews Connell from Eye Surgery Associates in Melbourne.
They discuss the importance of medical auditing and self-evaluation and helpful tools enabling surgeons to audit their own outcomes. Although this is mandated in specialities like vascular surgery, it isn’t in ophthalmology. But it can drastically improve performance.
In the episode, Del Porto discusses how an audit of her own cataract surgeries showed her prediction error for spherical outcomes was -0.14 D. Although she suspected surgery was resulting in patients being slightly myopic, having solid data helped her inform planning for future surgeries.
Connell discusses key barriers to uptake, including labour intensive data management, and some colleagues not seeing the benefits of auditing or adopting a belief their results are already good. He’s even heard a case of a specialist who thought the stress of knowing their outcomes would make them worse. However, he says most surgeons are motivated to know, but a lack of IT proficiency and specific platforms can make it challenging.
Reflecting on the episode, Del Porto says: “You’re never going to improve your outcomes without knowing where your deficits are. As ophthalmologists we perform auditing better than some other specialties, but there is definitely room for improvement, so it’s important to encourage it.”
In the second episode, Del Porto speaks with Borovik about what patients and referrers want from ophthalmologists, focussing on research from Cerner Enviza (formerly Kantar Health).
“When an optometrist is referring for cataracts, they want a detailed letter back and want to know any post-operative complications. They want to be part of a holistic care of the patient, so that was an interesting point of discussion. It also disappoints them when the ophthalmologist sends the patient off for ready-made reading glasses from the pharmacy when they could be sent back to the optometrist for more stylish glasses that will fit them better and provide better vision,” she says.
“We also focused on patient expectations – and there was a post-operative simulation of what patients would see if they were given a monofocal lens versus an EDOF versus a multifocal lens. It was interesting to see, given that scenario, most patients wanted something that was going to correct their presbyopia. So I think the days of leaving everyone presbyopic after cataract surgery are over.”
In the third episode, Del Porto interviews Trinh who in 2020 presented a widely-viewed presentation at The Toronto Eye Review that can be accessed on YouTube. It was an analysis of the unconscious way both men and women exhibit subtle implicit bias on a daily basis and its impact on women.
“She’s got a lot of research to back her up, and your mind is blown once you watch her presentation – you don’t realise how insidious it is,” Del Porto says.
“We discuss how it’s not just male patients who ask me – after I’ve consented them for cataract surgery – if I’m actually going to do the operation. We also cover unconscious gender bias in referrers, colleagues, people beneath and above you. We talked about a few of our experiences as well – it got deep and philosophical.”
In the episode on presbyopic-correcting IOLs, Del Porto and Agarwal question what is driving increased uptake – technological advances or patient demands to be spectacle-free?
“One feeds the other, doesn’t it? Patient demand requires the technology to keep up and move faster. But at the same time, technological advances are contributing to patients making these further demands,” Del Porto explains.
The fifth and final episode features Del Porto and Melbourne colleague Beltz discussing modern-day training of the next generation of ophthalmologists. With rapid advances occurring in the field, they say what’s learned as a trainee won’t necessarily sustain ophthalmologists throughout their career.
They argue that being a good learner is just as important as strong skill and technique.
Beltz is the founder of GENEYE in 2019, part of the Eye and Ear Education program. It focuses on integrating modern immersive educational techniques, high performance psychology and technologies such as virtual reality surgical simulation.
“There is a new teaching lab opening at the Eye and Ear soon, and Dr Beltz is really excited about that, but the point of the episode is that a good ophthalmologist will constantly be updating their skill set. Sometimes it’s the trainee teaching the consultant, learning is not necessarily hierarchical; and that is how Dr Beltz has run things at her GENEYE conferences,” Del Porto says.
Australian ophthalmology podcast Podthalmology is available at benchtobedside.com.au.