FRCOphth, CertLRS.
Vision correction surgery @ Cleveland Clinic Abu Dhabi
+971 2 665 2051
Refractive lens exchange
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 glasses or bifocals.
Refractive lens exchange typically is for people above the age of 50 with presbyopia or younger people with 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) in older individuals, but generally, it is not recommended if LASIK, PRK or phakic IOLs are suitable options.
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.
As in cataract surgery, three types of IOLs are available to replace your natural lens, depending on your vision needs and the health of your eyes. They are:
Monofocal fixed-focus IOLs. Monofocal lenses provide clear vision at distance, intermediate or near ranges — but not all three at once. Toric IOLs to correct astigmatism also are classified as monofocal IOLs.
Multifocal IOLs. A multifocal lens provides clear vision at multiple distances.
RLE surgery
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.
RLE surgery is usually done under local anaesthesia, so typically there is no discomfort, and most people report vision improvement soon after surgery.
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 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.
Risks and side effects of surgery
Refractive lens exchange is performed essentially the same way as cataract surgery, and therefore RLE complications are similar to cataract surgery complications.
Lens replacement surgery is more invasive than laser-based refractive surgery such as LASIK and PRK and comes with slightly more risk.
However, sight-threatening complications are rare, and most complications can be treated successfully with medication or additional surgery.
While refractive lens exchange has been proven safe and effective, all surgery has some degree of risk, which you should discuss in detail with your eye surgeon. Refractive lens exchange risks and complications include:
Retinal detachment, especially in extremely nearsighted people
Dislocated IOL
Increased eye pressure (ocular hypertension)
Infection or bleeding inside the eye
Droopy eyelid (ptosis)
Glare, halos and blurry vision from multifocal IOLs
Refractive lens exchange is more invasive surgery with a higher risk of complications, compared with other vision correction procedures.
But the higher risks may be an acceptable trade-off if you have a severe refractive error and a strong desire to be less dependent on eyeglasses, contact lenses and/or reading glasses.