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What is Refractive Lens Exchange Surgery?

Are you tired of depending on glasses and contact lenses, especially reading glasses, but not suitable for LASIK?

Imagine seeing clearly and doing the activities you love without glasses slipping down your nose or constantly searching for your reading glasses.

Refractive lens exchange surgery (RLE), also known as clear lens replacement or clear lens exchange, can boost your distance and reading vision. Most patients achieve freedom from glasses for all tasks.

What Is RLE?

RLE, or Refractive Lens Exchange, is a surgical procedure similar to cataract removal in which the surgeon removes your eye's natural lens and replaces it with an artificial one. It helps restore patients' vision and usually eliminates the need to wear devices like contact lenses or glasses.

The most common reason to have RLE is in middle age, to restore near vision, which typically starts to blur around age 45 for most people.

The RLE procedure is popular, well tested, and well proven. But what does it involve, and what can you expect?

What Happens During RLE Surgery?

Ophthalmic surgeons no longer perform RLE surgery under general anaesthesia. Except in isolated cases, patients are awake and aware throughout the procedure. However, surgeons administer two things before the operation:

  1. They give a mild sedative to help the patient relax and stay calm throughout the procedure; this helps ensure that those who may be nervous about having anything near their eyes won't experience too much discomfort.
  2. The surgeon administers a local anaesthetic through eye drops; modern lens surgery generally no longer uses injections. Numbing drops ensure the patient won't feel any pain during the operation.

After administering the sedative and anaesthetic, the doctor will make a small incision about 3mm long in the edge of your cornea, allowing access to the lens. Since this hole is too small for the lens to pass through, they will use an ultrasound probe to break up your old lens, allowing easy removal.

The new intraocular lens (IOL), folded to fit through the hole, is then inserted into the eye and unfolded to cover the same area as the old lens.

The entire procedure takes about 15-20 minutes. If you have your eyes operated on different days, one eye is allowed to recover for at least one week before the surgeon repeats the process on the other eye. 

However, many patients now choose to have both eyes treated on the same day, which prevents imbalance between the eyes and is much more convenient.

After the procedure, the local anaesthetic will blur your vision for up to 48 hours, so you should arrange for someone else to escort you to and from the clinic.

You may feel discomfort and slight pain in your eye for a few days after the procedure, but your surgeon should prescribe anti-inflammatory medication to help relieve these symptoms.

You should notice improved vision one day after the procedure. The effects can be immediate. However, as your eye heals from the trauma, you may experience fluctuations.

Surgeons will generally advise avoiding overexertion for a few days after the procedure, but you should be able to continue routine everyday tasks within a day.

Who is Eligible for RLE?

Your optometrist will tell you whether RLE is a good option, but there are general guidelines for who will benefit from the procedure.

Age Groups

Generally, most clinicians don't recommend RLE to patients younger than 45 or 50, which is when people start needing glasses for close vision. 

Though studies have found that there's no substantial difference when younger people undergo the procedure, many surgeons are concerned that the rare vision-threatening complications of RLE can be more severe in more youthful, active patients.

Specific Vision Problems

RLE is an excellent solution for people who have vision problems falling into one (or more) of three categories:

  • Myopia, or short-sightedness. 
  • Hyperopia, or long-sightedness.
  • Astigmatism - an asymmetric curvature in the eye that leads to distorted vision.

RLE vs Other Procedures

Besides glasses or contact lenses, there are four other solutions for short-sightedness and long-sightedness. 

RLE vs LASIK

LASIK (laser-assisted in situ keratomileusis) is what most of us know as "laser eye surgery." 

It's a valuable solution for most of the same problems RLE aims to solve, but RLE and LASIK differ in a few key ways.

Whereas RLE replaces your eye's natural lens with an artificial one, LASIK reshapes the cornea by creating a small flap in its upper layers and using a laser to change its curvature. The reshaped cornea allows light to focus correctly on the retina, giving clear vision.

The main advantages are that LASIK is less intrusive (hence, you should experience less pain), and your recovery time is much shorter. With LASIK, both eyes are treated on the same day. However, with RLE, you may need to wait a week or more between eyes.

However, only some people are suitable for LASIK. 

People with extreme prescriptions may not be suitable candidates for LASIK. Because it removes tissue, the laser eye procedure works only for those with a thick enough cornea.

RLE vs PRK (LASEK)

Photorefractive Keratectomy, or PRK, is the other form of laser eye surgery. It's similar to LASIK in most ways (e.g., it uses the same laser to reshape the cornea and has a similar procedure length), but PRK has a longer recovery time.

The main difference between PRK and LASIK is that PRK doesn't reshape the cornea by creating a flap. Instead, it removes the microscopic outer layer of your cornea, which will grow back over time. This regrowth time accounts for the longer recovery delay compared to LASIK.

PRK is also quicker to perform than RLE (5-6 minutes for PRK compared to 15-20 for RLE). PRK is less invasive and can be carried out in a laser suite, whereas RLE must be performed in an operating theatre.

RLE vs ICL

An implantable contact lens, or ICL, is another alternative to RLE, but RLE and ICL have key differences.

ICL implants a lens between the iris and your natural lens, similar to a permanent contact lens, and is a great option that's usually recommended for patients younger than 45. 

With ICL, the surgeon doesn’t remove your natural lens, which matters because, in younger patients, the lens can still flex and focus on near objects, avoiding the need for reading glasses.

The process also takes less than half an hour, like RLE, and recovery takes about two days. 

There's no real difference in side effects; the main difference is that ICL is perfect for younger patients.

Advantages Of RLE

Now you may be wondering if RLE is a good solution for you. To re-emphasise, your optometrist or eye surgeon should be the final authority on this, but if they recommend RLE, here are some of the advantages you may experience:

  1. RLE works for patients with thin corneas or other issues when laser surgery may not be a suitable treatment option.
  2. No more reliance on glasses. Whether short-sighted or long-sighted, you no longer need glasses, bifocals, or multifocal lenses. The premium multifocal implants used for RLE typically allow patients to read without glasses. No more forgetting where you left your glasses or accidentally leaving them at home, and no more steam building up in front of your eyes.
  3. No more contact lenses. After an RLE procedure, the frustrations of regularly replacing them, cleaning them, and sticking a finger in your eye to place and remove them will be gone forever.
  4. RLE solves various vision problems, including myopia, hyperopia, astigmatism, and the need for reading glasses if you opt for a premium multifocal IOL.
  5. RLE has a relatively short recovery time. You can return to your regular day-to-day routine within a day or two.
  6. RLE eliminates the possibility of developing cataracts in the future since your natural lens (which can develop cataracts) is no longer in your eye.

Disadvantages Of RLE

Like all procedures, RLE has a few drawbacks. 

However, most of these disadvantages are outweighed by the advantages. So if your optometrist recommends the process, be reassured. 

Still, discuss the issues with your optometrist to understand how they might affect you. 

Some of the drawbacks include the following:

  1. RLE is more intrusive than other types of eye surgery. The surgeon will physically make an incision at the edge of your cornea and remove the natural lens, which doesn't happen with LASIK or PRK. Very few cases have caused further problems; however, if something does happen, additional surgery can usually correct it.
  2. You must take some extra care after the surgery. Your vision will be good within a few days, but that doesn't mean your eyes have recovered fully. You must take precautions for a few weeks, such as not wearing eye makeup, keeping soap and other chemicals out of your eyes, and not putting pressure on them.
  3. RLE is usually more expensive than other treatment options. Because you have to book two separate surgical procedures (one for each eye) and the surgeon uses replacement lenses, the cost can be much higher than laser treatments. However, RLE is still worth the expense when you factor in the money you will save on glasses and contact lenses.

Learn more about RLE recovery and aftercare.

Conclusion

RLE surgery is an excellent option if you want to stop bothering with glasses or contact lenses, aren’t suitable for a treatment like LASIK, or want a permanent solution for needing reading glasses. 

It can help prevent cataracts from developing in the future, and for some people, it's the only surgical option. 

The procedure is well established and proven, so if your optometrist recommends RLE, rest assured your eyes are in good hands.

If you’re considering RLE but aren’t sure it’s right for you, or you would like to discuss alternatives, schedule a free telephone consultation with a member of our team, and they’ll be happy to talk you through the treatments best suited to your prescription. You can contact us here.

Learn what to expect before and after RLE surgery.

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