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Mr David Allamby
MD, FRCOphth, FRCS
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.
RLE, or Refractive Lens Exchange, is a surgical operation similar to cataract removal, during 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 popular reason to have RLE is in middle age to help restore near vision, which typically starts to blur over the age of 45 or so for most people.
The RLE procedure is popular, tested, and well-proven. But what does it involve, and what can you expect from it?
Ophthalmic surgeons don't perform RLE surgery using general anaesthetic anymore. Except in isolated cases, patients are awake and aware throughout the procedure. However, surgeons administer two things before 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), which is folded up 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 having your eyes operated on different days, one eye is allowed to recover for at least one week before the surgeon repeats the process on your other eye.
However, many patients now choose to have both eyes treated on the same day, which prevents an imbalance between the eyes and is much more convenient for patients.
After the procedure, the local anaesthetic will cause your vision to blur 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 an improvement in your 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 over-exerting yourself for a few days after the procedure, but you should be able to continue with routine everyday tasks within a day.
Your optometrist will tell you if RLE is a good option, but there are some general guidelines regarding who will benefit from the procedure.
Generally speaking, most clinicians don't consider recommending RLE to patients younger than 45 or 50, which is the age when people start to need 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.
RLE is an excellent solution for people who have vision problems falling into one (or more) of three categories:
Apart from wearing glasses or using contact lenses, there are four other solutions to short-sight and long-sight.
LASIK (laser-assisted in situ keratomileuses) is what most of us know as "laser eye surgery."
It's a valuable solution to most of the same problems RLE aims to solve, but there are a few distinct differences between RLE and LASIK.
Whereas RLE replaces your eye's natural lens with an artificial replacement, LASIK reshapes the eye's cornea by creating a small flap in its upper layers and using a laser to change the corneal curvature. The re-shaped 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, occasionally there can be a week or more wait between eyes with RLE.
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 will only work on those with a thick enough cornea.
Photorefractive Keratectomy, or PRK, is the other form of laser eye surgery. It's similar to LASIK in most ways, e.g. uses the same laser to reshape the cornea, length of the procedure, etc., 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. The time taken for this regrowth accounts for the delay in recovery 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.
Implantable Contact Lens, or ICL, is another alternative to RLE, but there are some key differences between RLE and ICL.
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 old lens, which is important 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 the recovery time is approximately two days.
There's no real difference in side effects; the main difference is that ICL is perfect for younger patients.
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:
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.
However, discuss the various issues with your optometrist to determine how they might impact you.
Some of the drawbacks include the following:
Learn more about RLE recovery and aftercare.
RLE surgery is an excellent option if you want to stop bothering with glasses or contact lenses and aren’t suitable for a treatment like LASIK or want a permanent solution for needing reading glasses.
It's a solution that will 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 that your eyes are in good hands.
If you’re considering RLE but don’t know if it’s the right treatment or you would like to discuss alternative treatment options, schedule a free telephone consultation with a member of our team, and they’d be happy to talk you through the treatments suitable for your prescription. You can contact us here.
Find out more about what you can expect before and after RLE surgery.
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