August 25, 2023

Who Is A Good Candidate For RLE?

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Lens Replacement Surgery, also called Refractive Lens Exchange (RLE), is a procedure in which the natural lens of the eye is removed and replaced with an intraocular lens (IOL). A vision correction procedure, RLE can give stable vision and make your sight clearer and brighter in many conditions.

This procedure is often performed to correct significant refractive errors, such as high degrees of myopia (nearsightedness), hyperopia (farsightedness and high farsightedness), or astigmatism, as well as presbyopia, a condition that affects near vision as people age.

Benefits of RLE

With a replacement artificial lens, your vision can be improved in the following ways:

  • More consistent vision, unaffected by variable conditions
  • Clearer and brighter vision
  • Eliminates or lessens the need for glasses or contact lenses
  • Rapid recovery from surgery
  • Few comparative post-op complications
  • Removal of cataracts and/or prevention of future cataract development
  • Improvement in glaucoma treatment with reduced pressure after lens exchange in many patients.

What Does RLE Surgery Involve?

If you and your optician decide that Refractive Lens Exchange is the best option, you will undergo a ten-minute procedure per eye.

You will be administered a mild sedative and some numbing eye drops. The skin around your eyes will also be sterilised and then covered. Securing your eyes open with an eyelid holder, a small incision will be made in the eye. 

Using ultrasound, the natural lens will be fragmented into pieces. Removing the old one, your surgeon will then implant the new intraocular lens (IOL) into your eye.

There are several lenses used in RLE, depending on the type of eye condition you are experiencing:

  • Standard Multifocal IOLs correct for clear distance vision.
  • Monovision IOLs fix the vision for distance in one eye whilst allowing nearby objects to look clear in the other.
  • Premium Multifocal IOLs correct vision at multiple ranges.

What Is the Process of Refractive Lens Exchange?

Here’s an overview of how lens replacement surgery works:

  1. Before the surgery, a thorough eye examination assesses your eye health, refractive error, corneal thickness, and other factors. The surgeon will also determine the most suitable IOL type and power for your specific prescription needs.
  2. The procedure is usually performed under local anaesthesia to numb the eye and ensure comfort throughout the surgery. A small incision is made in the cornea to access the eye’s natural lens.
  3. The natural lens is carefully removed. This is typically done using phacoemulsification, which involves ultrasound energy to break up the lens before removal.
  4. The artificial intraocular lens (IOL) is inserted into the exact location where the natural lens used to be. Various types of IOLs are available, including monofocal, multifocal, and toric lenses. Monofocal lenses are commonly used to correct a single focal point (usually distance vision), while multifocal and toric lenses can correct both distance and near vision and astigmatism.
  5. The surgeon ensures the IOL is positioned correctly within the eye to provide optimal vision correction. The power and type of IOL are chosen based on your specific refractive needs and any other vision issues you may have.
  6. The small incisions in the cornea are self-closing and require no further attention.
  7. Recovery time varies, but many patients experience improved vision within a few days after surgery. Eye drops and medications might be prescribed to prevent infection and reduce inflammation.
  8. Regular follow-up appointments are scheduled to monitor your healing progress and ensure the vision-correcting lenses function as intended.

What Are the Differences Between RLE and LASIK?

LASIK (laser eye surgery) is the most popular treatment for myopia, hyperopia, and astigmatism. However, it is not commonly used for extreme prescriptions or where ageing changes are present in the lens (lens dysfunction syndrome).

Adding or replacing lenses, such as RLE, is preferable for high hyperopia prescriptions (farsightedness). 

Am I a Good Candidate for RLE?

Refractive Lens Exchange is used to treat several types of prescriptions. Consulting with an experienced eye surgeon is crucial to determine if you’re a suitable candidate and understand the benefits and risks of refractive lens exchange surgery.

You will often be a good candidate for RLE if any of the following apply to you:

  • You are over the age of 45-50
  • You have presbyopia (a refractive error making it hard to see things up close, impacting those in middle age as the lens stops focusing light correctly)
  • You suffer from myopia, hyperopia or astigmatism
  • Your prescription prohibits you from LASIK
  • You are unhappy wearing glasses or contact lenses
  • Suffering from early cataracts
  • You have thin corneas, which prohibit you from laser eye surgery (as it requires suitable corneal tissue to reshape)

Are There Any Risks with Lens Replacement Surgery?

Any kind of eye surgery comes with risks, though Focus Clinics holds itself to high standards for safety and patient satisfaction.

Surgically correcting refractive errors carries a handful of potential risks. It’s important to thoroughly discuss these risks with your eye surgeon and make an informed decision based on your individual circumstances. Here are some potential risks associated with lens replacement surgery:

  • Blurred vision for a few days post-op
  • Night vision disturbances include halos, glares, and starbursts in low-light conditions.
  • Swelling or bleeding of the eyes
  • Retinal detachment (in which the retina pulls away from its blood supply, causing blurred vision, loss of peripherals, flashes and floaters, potentially leading to blindness)
  • IOL dislocation is when, in rare cases, the implanted intraocular lens (IOL) may become dislocated or move from its intended position.
  • Capsular opacification (a common post-op event and not a complication, resulting in reduced vision similar to cataracts, in which cells spread over the capsule behind the implant. It is readily treatable by YAG laser capsulotomy as an out-patient)
  • Endophthalmitis is a severe, though rare, eye infection that can lead to rapid and severe vision loss if not treated promptly.
  • Dry eye can be experienced by some patients, either temporarily or with prolonged dry eye symptoms after surgery. This can cause discomfort and impact vision quality.
  • Undercorrection or overcorrection because, while the goal is to achieve accurate vision correction, there’s a possibility of under-correction (not achieving the desired level of vision correction) or over-correction (over-correcting the refractive error).

It’s important to remember that while these risks exist, Focus Clinics have a high success rate and have helped many individuals achieve improved vision and quality of life. 

A thorough pre-operative assessment, open communication with your surgeon, and adherence to post-operative care instructions will help minimise risks and optimise outcomes.

Why Choose Focus Clinics for Lens Replacement Surgery?

Focus Clinics are specialists in outstanding results. For example, we have a unique 100% success rate for 20/20 vision for short-sighted LASIK. This impeccable record is important to us — a 98% success rate is no good if you fall into that unlucky 2%. 

We work hard to ensure that your eyes are healthy, as shown by a 5/5 top rating on TrustPilot. That’s the highest trust rating out of every ‘eye treatment’ clinic.

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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