Refractive Lens Exchange (RLE) is a procedure almost identical to cataract surgery (the most common operation in the Western World), only it is done for a slightly different reason.
Instead of a cloudy lens of the cataract being replaced, the Refractive Lens Exchange procedure replaces your eye’s natural clear lens with an artificial intraocular lens (IOL). This reduces your need for glasses or contact lenses by correcting your refractive error to gain a sharper focus. IOL implantation is a bit like building your glasses or your contact lenses into your eyes.
Refractive Lens Exchange (also called lens replacement surgery or clear lens extraction) may be a better alternative than LASIK, PRK or IOL refractive surgery for people with presbyopia (age related loss of near vision) and high hyperopia (far sightedness). The procedure is designed to help you to live an active lifestyle without the reliance on glasses and contact lenses.
Laser Eye Surgery is usually a good solution for near sightedness and far sightedness for younger people, but as we get older, our eyes’ natural lenses become both harder and hazier. Harder lenses aren’t able to adjust for near vision and hazy lenses start to scatter light and blur vision and develop into a cataract. RLE replaces the problem lens in your eye with a new lens implant.
Who is a suitable candidate for RLE?
RLE is elective - you can choose to have it at any time, or not at all. The alternative is staying in glasses or contact lenses. RLE is most suitable for people who have presbyopia and hyperopia (far sightedness) over the age of 45 years.
Presbyopia affects just about everyone and becomes noticeable sometime in the mid 40’s. Presbyopia is a naturally occurring age-related condition where your eye’s natural lens becomes firm and inflexible and you lose the ability to focus on near objects, such as reading your phone or a book. Standard Laser Eye surgery such as LASIK, PRK and phakic IOLs cannot help treat presbyopia. Laser Blended Vision and RLE are often the most suitable surgical options for this group of people who wish to be free from their distance and reading glasses. If you are over 50 years of age and have a glasses prescription that is higher than the normal range for laser eye surgery, you are more likely to be suitable for RLE.
RLE removes the need for cataract surgery in later life, and is often preferred to laser vision correction for patients in the retirement age group whose eyes are in the early stages of cataract formation and are looking for an alternative to glasses and who are no longer suitable candidates for LASIK. For this group of people the RLE does two procedures in one - removes the early cataract and replaces it with a lens; minimising surgical procedures (no need to have cataract surgery later in life) and maximising quality of life without the hassle of glasses.
Myopia (short sightedness) or hyperopia (far sightedness) can be corrected by RLE and there are IOLs available that have built in correction for astigmatism.
Your ophthalmologist will advise you on your best treatment options after assessing your eye test measurements and your eye health.
Who is not a suitable candidate for RLE?
Some myopic patients are not suitable candidates for RLE due to the risk of a retinal detachment and phakic IOL may be a better option in a younger person.
RLE is not a suitable option for everyone with certain eye diseases that may degrade image formation e.g are-related macular degeneration, uncontrolled diabetes or diabetic retinopathy, uncontrolled glaucoma, recurrent inflammatory eye disease and previous keratorefractive surgery.
What type of lenses shall I choose?
Like cataract surgery there are three types of IOL that are available to replace your natural lens. The choice will depend upon your vision needs and the health of your eyes.
Monofocal fixed-focus IOLs will give you clear vision at either distance, intermediate or near ranges.
Toric IOLs will correct astigmatism are also available as monofocal IOLs.
Monofocal IOLs can be used to treat your eyes equally focused in the distance or as blended vision to give you distance and near vision.
Multifocal IOLs provide vision at multiple distances. The replacement lens in each eye with the implant will give good distance, intermediate and near vision so you are unlikely to need glasses for any tasks. This is one of the options for those people who wish to have good near vision without glasses. There is often a period of adjusting to get used to the change in vision and some people notice halo or glare with bright lights at night.
You won’t feel an IOL in your eye. The lens implant is inside your eye and is not visible to others.
Your ophthalmologist will discuss the lens selection with you and carefully tailor it to your preferences and life style.
What does the procedure involve?
The procedure for refractive lens exchange is virtually identical to cataract surgery.
The difference is that in RLE, the lens in your eye being replaced is clear, rather than a cloudy lens due to a cataract.
Refractive lens exchange is done as an outpatient procedure taking about 10-15 minutes and you will be normally at the hospital for around 2 hours. Each eye is normally done separately, a week apart. This gives time to recover from the first surgery and also a guide as to how your vision is with the prescribed lens.
You will be awake during the procedure and anaesthetic eye drops are used to numb your eyes, so there is no discomfort.
Arrange for someone to drive you home and return you the following day for a check up.
You will be given medicated eye drops to use for about 3 weeks.
Initial recovery usually takes about a week and it may take several weeks before you notice any significant changes in your vision.
You should be able to return to work and drive again within a week of your surgery.
What are the risks of having a RLE procedure?
In all forms of eye surgery, problems can occur during the operation or afterwards in the healing period.
Lens replacement surgery is more invasive than laser-based refractive surgery such as LASIK and PRK and therefore comes with slightly more risk.
Most complications can be treated successfully with medication or additional surgery. At your follow up appointments your ophthalmologist will check your progress and monitor you for any complications.
Refractive Lens Exchange risks and complications may include:
retinal detachment, more common in extremely myopic (nearsighted) people
dislocated IOL
increased eye pressure
infection or bleeding inside the eye
droopy eyelid
glare, halos and blurry vision from multifocal IOLs.
Will having RLE affect my future eye health care?
If you develop a new eye health problem later in life, RLE implantation should not prevent you having successful treatment.
What is the cost?
If you have a cataract the RLE may be covered by your insurance.
The cost of the procedure varies depending on the IOL option you choose and will be discussed with you personally at your consultation.
Phone Bowen Eye Clinic 0800 69 2020 to book an assessment.
Glossary:
Astigmatism irregular defocus, or an eye that is shaped more like a rugby ball. Most of us have at least some astigmatism.
Cataract when the natural lens gets misty enough to make vision hazy, it is called a cataract.
Hyperopia far sightedness. People with hyperopia typically have good vision as young adults. As they get older, they find themselves reliant on glasses for reading and then for the distance vision too.
IOL intraocular lens. IOLs are small synthetic lens implants that are used to replace the natural lens in cataract and refractive lens exchange.
LASIK (Laser-In-Situ-Keratomileusis) This is the commonest form of laser vision correction in which a thin protective flap is created using a femtosecond laser. The protective flap is hinged aside by the surgeon before optical reshaping of the cornea using an excimer laser. The flap is then replaced, and adheres without stitches, keeping the corneal skin layer intact and giving a fast visual recovery.
Myopia near sightedness. People with myopia are able to see up close but not in the distance. They typically first need glasses as school age children.
Presbyopia age related loss of reading vision and the ability to focus on a near object without help from glasses.
PRK (photorefractive keratectomy) this is a form of surface laser vision correction treatment in which optical reshaping of the cornea is done with an excimer laser on the corneal surface after removal of the corneal skin layer.
Refractive Surgery is another name for vision correction surgery or surgery to reduce the need for glasses or contact lenses.
RLE (refractive lens exchange) this is surgery to replace the natural lens with an IOL. RLE is identical to cataract surgery but is performed in patients who can see clearly if they wear glasses or contact lenses. The aim of RLE is to help people to see clearly for more activities without glasses or contact lenses.
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