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You could be considering other treatments if you’re not a candidate for LASIK. The most popular non-laser treatments are refractive lens exchange surgery (RLE) and implantable contact lens surgery (ICL).

But while treatments like RLE and ICL might sound similar, they correct vision differently.

So what are the differences between RLE and ICL?

Refractive Lens Exchange is mainly for candidates over 40 who are not good LASIK candidates or are looking for a permanent solution for reading glasses. RLE is used to treat moderate to severe short-sight (myopia), long-sight (hyperopia), astigmatism and the need for reading glasses (presbyopia). 

On the other hand, Implantable Contact Lenses are best for candidates between 21 and 50 with mild to severe myopia, with or without astigmatism.

RLE and ICL are excellent eye treatments for the correct patients and have widened the number of candidates who can benefit from refractive surgery, e.g. when LASIK is not a good option. 

Let’s look at what they entail, what they treat, and who is the ideal candidate for each.

Refractive Lens Exchange (RLE)

RLE is a procedure that involves replacing your natural crystalline lens with a synthetic one. 

As we age, the lens inside our eyes loses its ability to focus on nearby objects, beginning in the 40s.

When you undergo RLE, part of the treatment involves breaking up your natural lens and replacing it with an artificial one with improved optics. 

The new, synthetic lens will allow you to see more clearly and prevent you from developing cataracts in the future.

The phenomenon of age-related near vision loss is also known as presbyopia. Presbyopia is the main reason for undergoing RLE for patients over 45.

RLE can also treat the following vision issues for the appropriate candidates:

  • Myopia (nearsightedness, short-sightedness)
  • Hyperopia (farsightedness, long-sightedness)
  • Astigmatism

Interestingly, the operation for RLE is almost identical to that of modern cataract surgery. 

In both cataract surgery and RLE, the natural lens is replaced with a synthetic one; the result of improved eyesight for the patient is the same.

The main difference between the two surgeries is the purpose. 

Cataracts cause poor vision because the clear lens becomes cloudy or opaque. In cataract surgery, the desired outcome is restoring vision by replacing the cloudy lens with a clear one. 

In RLE surgery, the desired result is usually restoring the ability to focus on near objects, often correcting distance vision problems simultaneously.

In RLE (and cataract surgery), the lens implanted into the patient’s eye is called an intraocular lens (IOL). This pivotal piece of technology is the basis for successful RLE, and there are several lenses from which patients can choose.

  • Multifocal IOL: This IOL has multiple points of focus. It can focus both near and far vision.
  • Basic monofocal IOL: Cear distance vision is the usual goal with this IOL.
  • Extended Depth of Focus (EDOF) IOL: These lenses can offer excellent near, medium, and far vision using a lens technology that minimises night glare and halos.
  • Toric IOL: This IOL corrects astigmatism and can be included with monofocal, multifocal or extended depth of focus style lenses.

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.

About RLE Surgery

RLE surgery takes 15-20 minutes, and you’ll be in the clinic for around 3 or 4 hours.

It can take 6-12 weeks to adjust fully after the surgery. You should notice a marked improvement within a few days, and you can resume your usual activities about a week after surgery.

Before surgery, we will test your eyes to confirm their length and corneal curvature.

Your eye is then prepared for the surgery with anaesthetic drops, and a separator will keep your eyelids open.

A small opening is made across the front of the lens, which is then broken up with ultrasound and removed; this leaves a clear capsular bag into which the IOL is inserted.

What To Expect After RLE Surgery?

You can expect a permanent improvement in your eyesight after RLE. 

A significant benefit of undergoing RLE is that you will not develop cataracts later in life. The natural lens, which becomes cloudy in cataracts, has been removed. Cataracts cannot grow in synthetic lenses, so you will be saved from the worry of developing cataracts as you age.

Who Is A Good Candidate For RLE?

There are a few criteria to consider if you want RLE surgery.

Look at the list below. If you have two or more of the following, you may qualify for RLE:

  • You are over 40 years old
  • You have moderate to severe long-sightedness
  • You are not a good candidate for LASIK
  • You have presbyopia (the need for reading glasses)

Implantable Collamer Lens (ICL)

ICL is a procedure that involves inserting a synthetic lens behind your iris and in front of your crystalline lens. 

It is a permanent eyesight solution for the correct candidates but is reversible if necessary.

ICL can correct the following vision issues:

  • Myopia (nearsightedness), including severe short-sightedness
  • Hyperopia (long-sightedness)
  • Astigmatism

One of the main benefits of ICL is the rapid results patients enjoy after surgery. The procedure is relatively quick. Many patients see a marked improvement at the end of the treatment.

The ICL itself is extremely thin and made of a special polymer. It does not alter the shape of your cornea.

About ICL Surgery

ICL surgery lasts about 15-30 minutes, and you will be in the clinic for around 4 hours. Although you can often see an immediate improvement in your vision, recovery can take up to 48 hours.

During recovery, your eyes may feel gritty or blurry. It’s best not to rub them for a few days.

Before surgery, the internal structures of your eyes are measured to ensure sufficient fluid flow in your eyes after the implant.

On the day of the surgery, your eye will be prepared with anaesthetic and dilating eye drops. A separator keeps your eyelids open during the procedure.

A small incision is made on the outer edge of the cornea, and the lens is inserted through it and then positioned correctly.

What To Expect After ICL Surgery

After ICL surgery, you can expect much better vision, even for extreme prescriptions. You can enjoy minimal night glare and halos; your eyes will even have UV protection from the Collamer lens material.

This procedure offers predictable, stable results for the correct candidates.

Who Is A Good Candidate For ICL?

There are a few criteria to consider if you want ICL surgery.

Look at the list below. If you have two or more of the following, you may qualify for ICL:

  • You are between 21-50 years old
  • You have had no significant changes in your vision in the last six months
  • You have no history of eye disease
  • You have mild to severe myopia
  • You have mild to severe hyperopia
  • You have astigmatism
  • You tend to get or want to avoid getting dry eye syndrome

RLE vs ICL: Which Is Better?

It’s impossible to compare the two procedures to decide which is better as both are successful procedures for the correct candidate.

  • RLE is for for middle-aged adults who want better vision, often for reading
  • ICL is for young to middle-aged adults who suffer from short-sightedness (with or without astigmatism) and who are not suitable for LASIK. It may be suitable for some long-sighted patients too

If you want a reversible procedure that does not alter your cornea but assists your prescription, then ICL is the better choice.

If your natural lens has become weakened and can no longer focus on certain distances, RLE is the better option.

Both treatments are viable alternatives for those with vision challenges and can provide relief from ongoing maintenance and upkeep of eyewear.


RLE and ICL are both forms of corrective eye surgery that are excellent alternatives to LASIK.

However, while both procedures involve implanting a lens into the eye, some key differences exist. 

During RLE, the natural crystalline lens is replaced with a synthetic one. In contrast, during ICL, an additional lens is placed between the iris and crystalline lens, almost like a permanent contact lens. 

If you’re considering eye surgery but don’t know which treatment is right for you, schedule a free telephone consultation with a member of our team. They’d be happy to talk you through the different options and identify which treatment is suitable for your prescription and need.

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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