REFRACTIVE LENS EXCHANGE (RLE)

Refractive lens exchange, also called lens replacement surgery or clear lens extraction, may be a better option than LASIK, PRK or phakic IOL refractive surgery for people with presbyopia and high hyperopia (farsightedness).

Refractive lens exchange (RLE) replaces your eye’s clear natural lens with an artificial intraocular lens (IOL) to correct your refractive error and achieve sharper focus, reducing your need for reading glassesor bifocals.

While lens replacement surgery technically does not have FDA approval, some eye surgeons will perform the procedure off label in certain circumstances. This is legal and sometimes is the most effective way to correct particular vision problems.

Refractive lens exchange typically is for people with presbyopia or extreme farsightedness, for whom LASIK, PRK or phakic IOL surgery generally are not suitable. If you have both presbyopia and moderate to severe hyperopia, RLE may be the only viable option for clear vision and minimal reliance on glasses after refractive surgery.

Lens replacement surgery also can correct myopia(nearsightedness), but generally it is not recommended when LASIK, PRK or phakic IOLs are available.

The procedure for refractive lens exchange is virtually identical to cataract surgery. The difference is that in RLE, the lens being replaced is clear, rather than a cloudy lens due to a cataract.

Refractive Lens Exchange: The Procedure

Lens replacement surgery usually takes about 15 minutes and is performed on an outpatient basis. Each eye is done separately, usually about a week apart.Numbing anesthetic drops are used during RLE, so typically there is no discomfort, and most people report immediate vision improvement after surgery.

BEST CANDIDATES

hyperopia, presbyopia, ineligibility for LASIK or phakic IOL

Initial recovery from refractive lens exchange — when you can resume normal everyday activities — usually takes about a week.Final outcomes of refractive lens exchange can take up to several weeks, and you may notice vision disturbances such as blurry vision, halos and glare, or a “scratchy” sensation as your eyes heal.You should be able to return to work and resume driving within a week of surgery, dependent on your eye surgeon’s instructions.Normally, you won’t feel an IOL in your eye, in the same way that you don’t feel a dental filling for a cavity. And since the lens implant is inside your eye and not on the surface like a contact lens, it’s not visible to others.

The artificial intraocular lens is a permanent replacement for your natural lens and is designed to last the rest of your life. Also, there is minimal risk of regression (loss of corrective effect or deterioration of vision) over time.

Refractive Lens Exchange For Presbyopia

Presbyopia affects just about everyone and becomes noticeable sometime after age 40 in most cases. Presbyopia is a naturally occurring age-related condition where your eye’s natural lens becomes more firm and inflexible, and you lose the ability to focus on near objects.

Refractive Lens Exchange vs. LASIK

While LASIK remains the most popular option for correcting myopia and hyperopia, if you have a very severe refractive error or an abnormal cornea, lens-based refractive surgery such as clear lens extraction or phakic IOL implantation may be a better alternative.

Unlike LASIK or PRK, refractive lens exchange can correct almost any degree of hyperopia, and visual acuity after RLE surgery often is better than LASIK and PRK outcomes in cases of moderate and high hyperopia.

If you have myopia, RLE usually is performed only if you are not a suitable candidate for any other vision correction surgery. People with myopia have a higher risk of retinal detachment during clear lens extraction, and other refractive surgery options should be explored first.
Also, you should consider carefully the cost of RLE. Lens replacement surgery is about double the cost of LASIK surgery and typically is not covered by vision insurance.

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