Refractive Lens Exchange vs Cataract Surgery

Refractive Lens Exchange vs Cataract Surgery

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Refractive Lens Exchange surgery (RLE) and cataract surgery are procedures designed to improve vision by removing and replacing the natural lens from the eye. However, their purpose and the patients they are meant for differ.

RLE is an alternative to LASIK for patients with presbyopia (needing reading glasses) who want to reduce their dependence on glasses or contact lenses.

Cataract surgery, on the other hand, is for patients who have developed cataracts and are experiencing a loss of vision.

Is Refractive Lens Exchange Different From Cataract Surgery?

While the procedure is the same, the obvious difference between refractive lens exchange and modern cataract surgery is that the latter is used when cataracts are present.

In RLE, the natural lens removed from the eye is healthy, but the patient no longer wishes to wear glasses or contact lenses. In contrast, the lens replaced during cataract surgery is degrading thanks to the presence of cataracts.

Refractive Lens Exchange patients have good vision when wearing glasses. Cataract patients have reduced vision, even if wearing glasses.

Both procedures use an intraocular lens (IOL) that replaces the natural lens and corrects vision. Modern premium implants can behave like bifocal or trifocal glasses, correcting vision at all ranges.

After RLE surgery, 80-93% of patients with a trifocal implant can be free from all glasses.

Not Sure Which Treatment Is Right For You?

We offer a number of vision correction treatments at our London Clinic.

We can give you a good idea of your suitability over the phone and schedule you for an initial consultation.

What Type Of Lenses Are Available for RLE Or Cataract Surgery? 

Refractive Lens Exchange and cataract surgery are not one-size-fits-all procedures, as the new lens must suit the patient’s needs. 

The options available depend on several factors, including eye health, the correction level needed, and budget.

Modern lenses fall into the following categories:

  • Extended depth-of-focus IOLs (EDOF) are for patients with presbyopia (needing reading glasses). They are unique for using a single corrective zone with an elongated focal point. EDOF implants are very good at giving excellent distance and intermediate (PC) range vision. Reading glasses may still be required.
  • Monofocal lenses are single-focus corrective lenses. If you have cataract surgery on the NHS, you will receive a monofocal lens, the most commonly implanted intraocular lens implant in the UK. Like wearing a pair of contact lenses for distance vision, expect to need reading glasses afterwards. 
  • Multifocal IOLs are lenses that work much like wearing bifocals or trifocal glasses. These lenses often eliminate the need for reading glasses, particularly trifocal designs. 
  • Toric lenses are used for patients with astigmatism.
  • Accommodative lenses use the eye’s muscles to change focus, allowing a complete (or nearly) vision correction. Early versions of accommodative lenses did not give satisfactory results. There are more designs currently being evaluated.
  • Light-adjustable lenses (LAL) are modern, adjustable monofocal lenses. Unlike regular monofocal lenses, these can still be adjusted after the surgery. After the eye has healed, the surgeon can still make custom corrections to the lens power. Patients typically have 2-4 non-invasive treatments to customise their implants. 

Should I Get RLE Or Wait For Cataract Surgery?

Some patients are advised to wait for cataract surgery instead of undergoing a refractive lens exchange. 

It can be frustrating news, given that the procedures are identical. From the patient’s point of view, why wait for cataracts when a refractive lens exchange allows me to avoid the condition altogether?

However, the reason for ophthalmologists being cautious has to do with risk. Generally, RLE and cataract surgeries are low-risk procedures, with around 1% experiencing significant complications. 

But the risk isn’t equally spread amongst patients. Some people are more likely to have complications or permanent vision damage from the procedure than others. For these people, it is safer not to have anything done until cataracts have developed further.

RLE risks run from very minor to severe, including:

  • Bleeding
  • Detached retina
  • Droopy eyelid
  • Dry eyes
  • Glaucoma
  • Glare
  • Halos
  • Infection
  • Over-correction of vision
  • Photic phenomena
  • Posterior capsule opacification (PCO)
  • Swelling of cornea or retina
  • Temporary increase in eye pressure
  • Under-correction of vision
  • Vision disturbances
  • Vision loss

Who Is A Poor Candidate For Refractive Lens Exchange? 

Who should have Refractive Lens Exchange surgery can be subjective. LASIK with blended vision can be suitable instead of the more invasive RLE procedure, especially for short-sighted (myopic) patients.

Myopic patients with more than -6 D lens correction pose a more significant challenge for RLE, with a higher risk of complications. However, high myopes are not necessarily poor candidates, but it makes them more likely to be refused if they have any other additional considerations.

Overall, regarding risk with RLE, the more short-sighted a patient is, the higher the concerns.

Patients with higher degrees of long-sightedness are generally better off with lens replacement surgery, as LASIK is prone to regression in these cases.

Many patients are more relaxed about having LASIK or PRK instead of RLE, which often is unfamiliar.


Refractive lens exchange and cataract surgery are procedures designed to improve a patient’s vision by removing and replacing the natural lens from the eye.

However, while the procedure is the same, RLE is for patients with presbyopia who want to reduce their reliance on glasses or contact lenses, while cataract surgery is for patients who are losing their vision due to cataracts.

If you’re considering RLE or cataract surgery, or you’re unsure which refractive surgery would be the best option, please book a free telephone consultation with a member of the Focus Clinics team. 

Call us to discuss your options and see which treatment is right for you.

About the Author

Mr David Allamby is the founder and medical director of Focus Clinic - the leading provider of laser eye surgery in London. Focus’ commitment is to be the #1 clinic for vision outcome results with 100% of patients achieving 20/20 vision or even better. He is one of a limited number of UK surgeons who work in laser refractive surgery full-time.


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