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Refractive Lens Exchange

Refractive Lens Exchange (RLE) is essentially cataract surgery, but exclusively for refractive purposes. Where cataract surgery is necessary to replace a cloudy lens which gives poor vision, in a refractive lens exchange procedure the same lens (which may not be defective) is removed and replaced to correct your prescription. RLE is often an appropriate alternative to laser eye surgery when the refractive error is too high to treat with the laser alone.

Exchange of the Natural Lens

In RLE the natural lens of the eye is removed and replaced with a silicone or plastic intra-ocular lens (IOL). The replacement IOL is of a power to correct most, if not all, of the patient's long or short sight. In order to achieve the desired focus for an eye it is sometimes necessary to use more than one type of procedure. This may be necessary if the focus error of the eye is too large or complex to be fully corrected by the RLE procedure alone. In most cases top up laser eye surgery is used to correct any residual refractive error. Combining procedures in this way is called Bioptics. Age is an important consideration and this procedure is generally only performed on patients who are 40+.

See Distance and Near

Most IOLs cannot accommodate by changing focus from distance to near like a young and healthy natural lens. Your eye will be set for either near vision or far vision. However, in some patients, there is the option to insert multifocal IOLs that can restore both distance and near vision. It is also possible to be corrected for monovision with RLE. Monovision is another method to receive some advantage of near and distant vision and resolve presbyopia.

Advantages of RLE

There are several advantages to RLE over other forms of refractive surgery. Some of the most obvious are that the surgery has years of successful history and the cornea is relatively untouched. If you have a thin cornea, dry eyes, or other minor cornea problems, RLE may be a better alternative. RLE may be the only option for people with high refractive error. Also, if the exact desired refractive change is not achieved, the IOL may be exchanged for one of a different power, or laser eye surgery may be used in combination with RLE to "fine tune" the correction (Bioptics). Because RLE removes the natural lens, there is no possibility of developing a cataract in the future. If you already have cataracts starting to form, RLE may make a lot of sense. There is little need to have surgery affecting the cornea if within a short period of time you will be having cataract surgery anyway.

Disadvantages of RLE

A disadvantage with RLE is that it is significantly more invasive surgery than any cornea-based refractive surgery. An extremely myopic patient would have an elevated risk of vitreous or retina problems after RLE. If you have accommodation, you will loose some or all accommodation. If you are already fully presbyopic and need powerful reading glasses or bifocals, the reduction of accommodation with RLE may not be a problem because you already have a very limited range of accommodation.

About the Surgery

Refractive lens exchange is a day case procedure, and can be performed under simple eye drop anaesthesia. The operation is not painful and good vision normally returns within 2 days of the surgery. Only one eye is operated on at a time, and typically the eyes are treated two weeks apart.