In this episode, instead of reviewing just one case, Sila Bal, MD, MPH, invites Neda Shamie, MD, to share her insights into challenging cases of astigmatism management during cataract surgery. Dr. Shamie explains how modern patients have higher expectations for optimized refractive outcomes and reviews her preferred techniques for astigmatism management in these cases. They discuss limbal relaxing incisions, arcuate incisions, and toric IOLs, and when to consider each approach based on the severity of astigmatism.