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Refractive Lens Exchange

What is refractive lens exchange (RLE)?

RLE is a surgical procedure in which the natural lens of the eye is removed and replaced with an artificial lens. RLE, sometimes called “clear lens extraction,” is most commonly performed on patients older than 40 who have high levels of hyperopia (better distance vision than near vision). RLE is also commonly performed on patients who are not good candidates for laser vision correction because of thin or flat corneas or high levels of hyperopia.

Because RLE eliminates the ability of the natural lens to adjust for reading and other activities that involve near vision, it may not be a good option for patients under 40, unless an accommodative or pseudo-accommodative IOL is used. (After about age 40, most people’s eyes begin to naturally lose their ability to focus at different distances.) A pseudo-accommodative lens may help with near vision or intermediate distance vision.

What are the potential benefits of RLE?

• Prevention of future cataract development.
• Good-to-excellent far vision following Single Vision Lens implantation (near working distance tasks still require eyeglasses).
• Good-to-excellent near, intermediate, and far vision with multi-focus lens implantation.
• Possible reduced likelihood of future need for laser vision correction or eyeglasses.

What types of lenses are used?

For those with farsightedness and presbyopia, refractive lens exchange is often the treatment of choice. During a refractive lens exchange procedure, the eye’s natural lens is removed and replaced with an intraocular lens (IOL). There are several IOL options to choose from, and your doctor can help you decide which one will best meet your needs.

• Single-focus IOLs: These lenses offer clearer near and distance vision. Lenses that treat astigmatism also fall into this category.
• Multi-focus IOLs: These lenses can reduce your dependence on glasses to see at far, intermediate and near working distances.
• Pseudo-accommodating IOLs: This lens automatically changes its position within your eye, providing less dependence on glasses at far and intermediate working distances.
• In addition to improving sight for qualified patients, refractive lens exchange can help prevent cataract development in the future.

What are the risks of RLE?

RLE is essentially a variation of cataract surgery. Cataract surgery is one of the most common surgeries in the United States. However, risks for these procedures include:

• A period of anisometropia, an imbalance between the eyes. This occurs because the operation on each eye is performed separately. The condition will resolve after the operation to the second eye.
• Potential mild discomfort for the first 24 hours after the procedure (severe pain is rare).
• Endophthalmitis, an intraocular infection that can lead to blindness. This occurs in 0.01 percent of cases after standard cataract or RLE procedures. If caught early and treated aggressively with antibiotics, the risk of vision loss can be reduced, but patients can lose their vision permanently.
• Posterior capsular opacification, a clouding of the eye’s natural lens capsule. This occurs in about 25 percent of cataract surgery patients but can be easily treated with a brief office laser procedure after the surgery.
• Retinal detachment.
• Cystoid macular edema, a swelling of the central area of the retina. This often can be improved with treatment, but some patients may experience permanent residual visual disturbances.
• Corneal edema, clouding and swelling of the front “window” of the eye. This condition is correctable with eyedrops, and may spontaneously heal naturally. In rare cases, a corneal transplant may be required.
• Iritis, an inflammation of the eye from mechanical irritation.
• Increased astigmatism.
• Glaucoma.
• With a Multi-focus or pseudo-accommodative IOL, patients may notice some degree of starburst, halos or glare around lights at night.

What should I expect on the day of surgery?

RLE is similar to cataract surgery. A very small incision, just two to three millimeters long, is made at the edge of the clear cornea, which is the transparent covering of the front of the eye.

A probe is inserted through the tiny incision and used to gently fragment the lens with high-frequency sound waves and remove the fragmented pieces. Once the lens has been removed, a tiny new clear implant lens is inserted in its place. RLE is typically performed on one eye first and then the second eye one to four weeks later, after the first eye has stabilized.

RLE is typically performed under local anesthesia in an ambulatory surgery center, but the type of anesthesia can be varied to best suit your needs. The procedure takes 15 to 30 minutes and your visit, including preoperative and postoperative care, will last one to two hours. You’ll need someone to drive you home after your surgery.

What should I expect during recovery and postoperative care?

The day after your surgery, you’ll come in for an office visit with your refractive surgeon to help ensure that you’re healing properly. Some patients have blurred vision the day after surgery, while some already see clearly – every patient heals differently.

Your sight should improve within a few days, although complete healing may take several months. For the first four to seven days after RLE surgery, you should avoid heavy lifting and bending over. After the first week, you can resume most of your normal activities, but you should minimize lifting heavy items, bending, and straining for the first month following surgery.

How can I learn more about this surgery and the lens implant options?

The following link discusses how the surgery is performed and the benefits of the different lens implant or IOL options. Though the video discusses cataract surgery, and we understand that you may not have cataracts, the elements of the surgical procedure and the lens implants options are similar for RLE procedures. Please note that the lens fees discussed in the video are for patients with cataracts needing treatment. Lens fees for RLE procedures will be different.

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