DIRECT ANSWER
Refractive lens exchange (RLE) replaces the eye's natural lens with an artificial intraocular lens (IOL) to improve vision. It is most often considered from the late 40s onwards, particularly for people with presbyopia who rely on reading glasses, and for those whose prescription or eye measurements make laser eye surgery less suitable. Each eye usually takes around 10 to 15 minutes, is performed as day surgery with anaesthetic eye drops, and the artificial lens is intended to stay in place permanently. Both eyes are usually treated on the same day.
Lens replacement surgery, also known as refractive lens exchange (RLE), refractive lens surgery or clear lens exchange, removes the natural lens inside the eye and replaces it with an artificial implant called an intraocular lens (IOL).
We can give you a good idea of your suitability over the phone and schedule you for an initial consultation.
RLE is technically the same procedure as cataract surgery. The difference for RLE surgery is that the natural lens is still clear, and it is replaced to improve vision and reduce the need for glasses. In cataract surgery, the lens has become misty or opaque and is replaced to restore transparency.
It is commonly considered for people in their mid-to-late 40s and beyond. The most common reason is to treat presbyopia, where the patient needs reading glasses to improve near vision.
RLE can also be performed for patients with prescriptions or eye anatomy that makes laser eye surgery a poor option, such as significant long-sightedness.
The procedure usually takes around 10 to 15 minutes per eye and is performed with anaesthetic eye drops. The artificial lens (IOL) is intended to remain in place permanently. Multifocal IOLs can give many patients good spectacle independence across distance and near vision (Alió et al., 2014 [1]).
✓ Also called refractive lens exchange (RLE) or clear lens exchange (CLE)
✓ Replaces the natural lens with a permanent intraocular lens
✓ Often considered for presbyopia and higher degrees of long-sightedness
✓ Usually takes around 10 to 15 minutes per eye
✓ Performed as day surgery using anaesthetic eye drops
✓ Both eye can usually be treated on the same day
✓ Different IOLs can be selected according to your visual needs
✓ Recovery to everyday activities commonly takes several days, while vision can continue settling for 4 to 8 weeks
RLE may be a better option than laser eye surgery, such as LASIK or PRK, for some patients, especially those who already need glasses for reading (presbyopia) or are significantly long-sighted (hyperopia).
Patients who are best suited for refractive lens surgery include:
Find out more about RLE eligibility.
RLE surgery replaces the clear natural lens inside the front part of your eye with an artificial intraocular lens (IOL). The technical procedure is very similar to cataract surgery, although in RLE no cataract is present and the natural lens being removed is still clear.
RLE surgery may be an option for those not suitable for LASIK
✓ Considered painless by most patients
✓ Performed as a day-case, with the whole visit lasting around 2 hours
✓ Treatment usually completed within about 15 minutes per eye
Lens replacement surgery usually takes between 10 and 15 minutes per eye and is performed as a day-case. You can usually have both eyes treated on the same day, or the eyes may be treated separately, typically one week apart.
Anaesthetic drops numb the eye during lens surgery, so most patients feel no pain, although you may notice pressure or unusual sensations during the procedure.
Most people see an immediate improvement in their vision after surgery, and recovery to your full schedule of activity usually takes between several days and up to one week. The final outcome of refractive lens surgery can take up to 4 to 8 weeks, and during this time you may notice changes in your vision, such as blur, halos or glare at night. You might also feel some dryness or a foreign-body sensation as your eyes heal.
You should expect to return to work and resume driving within a few days, and your surgeon will advise you accordingly.
The new lens lives inside your eye. You will not be able to feel it, and it is not visible to anyone talking to you; it can only be seen during an eye examination with a specialist. The artificial IOL is designed to permanently replace your natural lens and last for the rest of your life.
Speak to the team
We can give you a good idea of your suitability over the phone and schedule you for an initial consultation.
As with private cataract surgery, you will usually have three main implant (intraocular lens, IOL) choices after your natural lens is removed. The right choice depends on an assessment of your eyes, vision and post-surgery visual needs.
Here is a quick summary of the main lens implant choices. For a deeper discussion, see our Which IOL is right for me? page.
Lens implant | What it offers |
|---|---|
Standard monofocal IOL | Corrects distance vision only. Toric versions can also correct astigmatism. |
Monofocal with monovision | One eye is focused for sharp distance vision and the other for nearer tasks. A well-established approach, similar in principle to LASIK Blended Vision. |
Premium multifocal IOL (including EDOF) | Provides vision across multiple ranges, including distance, intermediate and near. Gives many patients good spectacle independence, though a minority notice haloes or glare at night, which is part of the discussion when choosing a lens (Alió et al., 2014 [1]). |
Lens choice is highly individual and is determined during a consultation with your surgeon, where you can discuss your visual needs after treatment. For more information on lens choices for your RLE surgery, see our IOLs page.
LASIK remains the most popular option for correcting short- and long-sightedness, including astigmatism.
However, for extreme prescriptions, and in some cases where the corneal anatomy is not fully normal, replacing the natural lens through refractive lens exchange, or adding a lens through phakic IOL or ICL surgery, can be better options.
This is most common with high degrees of long-sightedness, where the results can be better than what is possible with laser eye surgery. LASIK is best used up to around +3.00 to +4.00 dioptres of long-sight; above this level it becomes less predictable, with a higher rate of regression. Intraocular lenses can give a better and more stable outcome (Quito et al., 2013 [3]).
KEY DATA POINT
Hyperopic LASIK becomes less stable at higher corrections. The generally accepted ceiling is around +4.00 dioptres; above this, the enhancement (retreatment) rate rises to about 20% within a year, mainly because the corneal surface remodels and the correction partly regresses. For higher long-sight, replacing or adding a lens is often the more stable route (Quito et al., 2013 [3]).
High levels of short-sightedness (myopia) can be more problematic with lens exchange surgery, because of a higher risk of retinal detachment (see below). Lens replacement surgery is more expensive than LASIK, but it is the correct option for certain patients with high prescriptions.
The key difference is where the correction takes place. LASIK reshapes the cornea at the front of the eye, while refractive lens exchange replaces the natural lens inside the eye.
More advanced premium multifocal IOLs can now reduce or, for some patients, remove the need for reading glasses, bifocals or varifocals, improving both distance and reading vision. Improving close vision is the most common reason for performing refractive lens exchange.
Patients who are best suited for lens replacement surgery include:
Patient group | Details |
|---|---|
Long-sight (hyperopia) | Moderate to high degrees of long-sight |
Those aged 50+ who use reading glasses | |
Not suitable for laser or ICL | Those not suitable for LASIK or phakic IOL treatment |
Lens replacement surgery is most commonly used for people with presbyopia (using reading glasses after the age of 40) or higher degrees of long-sightedness, for whom laser eye surgery (LASIK, PRK or LASEK) or phakic IOL surgery are not options.
If you both need reading glasses and have moderate to severe hyperopia, so that your distance vision is quite blurred, lens surgery may be your best option to achieve clear vision with little or no reliance on glasses after your operation.
LASIK Blended Vision is used more commonly at Focus for many patients in their 40s and 50s, because of its demonstrated safety profile, combining better reading vision with treatment of any short-sight, long-sight or astigmatism. One of our surgeons can advise you on whether lens replacement surgery (RLE) or LASIK Blended Vision is right for you.
Lens replacement surgery and cataract surgery use essentially the same surgical principle: the natural lens is removed and replaced with an artificial intraocular lens.
The difference is why the lens is being removed. Cataract surgery removes a natural lens that has become cloudy. Refractive lens exchange removes a clear natural lens to replace it with an artificial lens, primarily to improve vision and reduce or eliminate the need for glasses.
Once the natural lens has been removed during RLE, it cannot develop a cataract later.
Most people notice improved vision soon after lens replacement surgery and can return to many normal activities within several days. Vision can continue changing as the eye settles, with the final result taking around 4 to 8 weeks. Temporary blur, glare, halos or dryness can occur during this period.
Our RLE recovery and aftercare guide explains what to expect in the first days and weeks after treatment.
Lens replacement surgery is more invasive than laser-based procedures such as LASIK or PRK, and carries a correspondingly higher, though still low, risk profile. Sight-threatening complications are rare, and most complications that do occur can be treated successfully (Alió et al., 2014 [1]).
KEY DATA POINT
The most important prescription-specific risk is retinal detachment in short-sighted (myopic) eyes. Removing the lens raises this risk above the already higher baseline of a highly myopic eye: a classic seven-year study of clear lens extraction for high myopia reported retinal detachment in about 8% of eyes, and the risk is greater in younger patients and longer (more myopic) eyes (Colin et al., 1999 [2]). This is a key reason RLE is approached with caution in high myopia and why careful retinal assessment is part of the work-up.
A full breakdown of risks, their likelihood, and how we screen to reduce them is covered on our safety and risks page.
A SURGEON'S PERSPECTIVE
Patients often assume lens replacement is a bigger step than it is, or confuse it with an implantable contact lens because both involve a lens. The right procedure depends on what your natural lens is still doing for you. If it is still focusing well, we look at LASIK or an ICL first. If reading vision or long-sightedness is the real problem, replacing the lens directly is usually the more lasting fix.
David Allamby, Medical Director, Focus Clinic
Book a Free Lens Replacement Consultation Today
Focus Clinic provides lens replacement surgery at its London clinic for patients suitable for refractive lens exchange who want to reduce their dependence on glasses.
The decision is not simply whether RLE can correct your prescription. Your surgeon will also consider whether replacing the natural lens is the right option compared with LASIK, PRK/LASEK or an implantable contact lens.
If you are considering lens replacement surgery or refractive lens exchange, book your free telephone consultation with one of our expert surgeons.
These answers are written and reviewed by Focus Clinic's chief surgeon, Mr David Allamby MD, who has performed more than 30,000 vision-correction procedures over 25 years. Focus is an Alcon-named Centre of Excellence and European training centre for ray-tracing-guided LASIK.
Most patients do not describe RLE surgery as painful. Anaesthetic eye drops numb the eye, although you may notice pressure or unusual sensations during the procedure.
RLE has a strong record of improving vision in appropriately selected patients, but a single success percentage can be misleading because success can mean different things. For one patient, it may mean reaching a certain level of unaided distance vision. For another, it may mean reducing dependence on reading glasses. Your likely outcome depends on your prescription, eye health, lens choice and visual priorities.
Yes, RLE surgery is permanent. Once your natural lens is removed, you can't put it back in. The artificial lens is designed to remain in the eye permanently, although it can occasionally be exchanged if medically necessary.
The main options are monofocal lenses for a single focal range, monofocal lenses used with monovision, and premium multifocal lenses (including EDOF lenses) designed to provide useful vision across more than one distance. The most suitable option depends on your eye measurements and how you use your vision day to day.
For an in-depth discussion on IOL choices available to you, please see our page covering all different lens options.
No. Cataracts develop in the eye's natural lens. Once that lens has been removed and replaced with an artificial IOL, it cannot develop a cataract later.
There is no practical difference. Refractive lens exchange, clear lens exchange, lens replacement surgery and refractive lens surgery are different names used for essentially the same procedure.
At Focus Clinic, RLE currently costs between £6,500 and £7,990 for both eyes, depending on the lens implant required. You can see the full breakdown on our RLE costs page.
The procedure usually takes around 10 to 15 minutes per eye and is performed as day surgery. Allow more time for preparation, checks and recovery at the clinic.
1. Alió JL, Grzybowski A, El Aswad A, Romaniuk D. Refractive lens exchange. Surv Ophthalmol. 2014;59(6):579-598. doi.org/10.1016/j.survophthal.2014.04.004
2. Colin J, Robinet A, Cochener B. Retinal detachment after clear lens extraction for high myopia: seven-year follow-up. Ophthalmology. 1999;106(12):2281-2284. pubmed.ncbi.nlm.nih.gov/10599657
3. Quito CFG, Agahan ALD, Evangelista RP. Long-term follow-up of laser in situ keratomileusis for hyperopia using a 213 nm wavelength solid-state laser. ISRN Ophthalmol. 2013;2013:276984. doi.org/10.1155/2013/276984
This page provides general information about refractive lens exchange and is not a substitute for personal medical advice. Prices are indicative and subject to change.
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