Refractive Lens Exchange (RLE)

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Last updated 3/7/2024
Reflective Lens exchange, Assil Gaur Eye Institute Los Angeles

What is refractive lens exchange (RLE)?

Refractive lens exchange is a surgical procedure involving removing your eye's natural lens and replacing it with a permanent "state-of-the-art super contact lens," such as the Johnson & Johnson Odyssey lens.  They are designed to improve vision without the need for contacts or glasses. 

Refractive lens exchange is a great alternative to LASIK, especially for those over 50.

Who is a good candidate for refractive lens exchange?

 

Suppose you've been told you're not a candidate for laser vision correction but wish to eliminate your dependency on glasses or contact lenses. In that case, RLE might be the right ‌procedure.

 

Our refractive lens exchange procedure is an alternative for individuals suffering from nearsightedness (myopia), farsightedness (hyperopia), astigmatism, or presbyopia (near vision loss due to aging). It's also suitable for people in the early stages of developing cataracts in one or both eyes. 

 

Is Refractive Lens Exchange (RLE) surgery like cataract surgery? 

Yes, refractive lens replacement surgery and cataract surgery are the same operations as both remove your eye's natural lens and exchange it for a new lens intended to be permanent. 

 

With standard cataract surgery, your clouded natural lens of the eye is replaced during a crystalline transparent lens exchange. This is any cataract procedure, and the difference is the lens selection; that’s it. 

 

Unlike LASIK or PRK, refractive lens exchange can correct a wider degree of hyperopia (farsightedness), myopia (nearsightedness), or astigmatism. This means RLE can be a better option than LASIK and PRK for patients with moderate and high hyperopia or myopia for individuals 40 years and older. 

 

And with the wide variety of artificial intraocular lenses available, you and your eye surgeon can select the lens type and combination that works best for you. Some patients even select a lens for near vision in one eye and far vision in the other If someone elects to have RLE, a premium lens would be offered to provide a full range of vision, in most cases, near, far, and intermediate.

 

 

What are my lens options with Refractive Lens Exchange? 

AGEI offers numerous types of lenses for refractive lens exchange. The choice of lens depends on factors such as the patient's visual needs, lifestyle, and any pre-existing ocular conditions and include:

 

Multifocal lens

Multifocal lenses allow patients to see objects at a distance and close. Just like glasses with bifocal or progressive lenses, this lens has different zones that allow our patients to see things at various distances. 

 

Accommodating lens

Accommodating IOL is a flexible artificial lens that acts more like your natural lens and can focus on multiple distances. Although this lens doesn't offer quite the sharpness of a multi-focal lens for near vision, the accommodating IOL can make you less likely to need reading glasses.

 

Toric lens

Toric IOL is for those with astigmatism or a more football-shaped cornea than a round. Astigmatism can make your vision blurry, not just close or far away. The Toric lens lessens astigmatism, so you won't need glasses to correct it after your RLE surgery.

 

Monofocal lens 

Monofocal IOLs are the simplest and oldest type of IOL options on the market. Unlike your natural lens, which can stretch or bend to help your eye focus at varying distances, this lens can only focus on a single fixed distance. Some patients are comfortable with their reading glasses and may prefer a monofocal IOL for crisp, clear-distance vision. But they will use reading glasses for near vision. 

 

Our surgeons will discuss which implantable lens option is right for you, given your vision needs, eye health, and lifestyle.

 

Schedule your consultation today with our internationally recognized eye surgeons

 

What to expect during RLE surgery 

RLE surgery is virtually painless, involves no bleeding, and typically uses no sutures (stitches). The procedure is done in our surgery center, and you go home right after your procedure.

 

After you are positioned comfortably, our surgeon places anesthetic eye drops into your eye so you feel no discomfort. If you need it, you can be given oral medication to help you relax. A small incision is made to remove the old lens, and then in five to seven minutes per eye, you are done! All you will feel is mild pressure during the procedure.

 

What to expect after RLE surgery 

Right after surgery, your vision may appear reddish due to the microscope light used in surgery. This will quickly resolve. Most patients will have blurred vision for a few days. For some, this may last for a couple of weeks. You may feel mild burning or stinging for the first 24 to 48 hours.

 

You will see our doctor the day after surgery and then one week later so we can keep a close watch on your healing progress. You can expect to return to your daily routine within a few days and return to driving one week after surgery. 

 

You will also be cautioned to avoid strenuous exercise and heavy lifting for a little while. Your eye will be fully stable in about eight weeks.

 

Why choose Assil Gaur Eye Institute for your refractive lens exchange surgery?

Our extensive experience in intraocular lens implantation makes us uniquely qualified to make this procedure the safest possible.

 

Our own Dr. Kerry Assil, one of the pioneers of laser lens implantation surgery, has been involved in developing and clinically testing numerous premium intraocular lens advancements over the years. Moreover, Dr. Assil was the first eye surgeon in the United States to use the ORA System for intraoperative vision testing during lens implantation.

 

Some of the steps we take to marry today’s most advanced technology with a meticulous surgical approach include:

  • We use state-of-the-art measuring systems to precisely obtain our patient’s eye power and intraocular lens size.
  • Use the LensAR Femtosecond laser, the most precise laser available today, to accurately define the shape and size of your natural lens.
  • Use our microsurgical approach, which performs lens exchange surgery through a 2mm incision. This allows for faster healing and vision recovery.
  • Using “cold” ultrasound technology during surgery to minimize eye swelling. This makes for safer surgery and promotes faster visual recovery.
  • AGEI surgeons are experienced in the implantation of a wide range of intraocular lenses so that we can fit you with the best product type and lens shape to match your eye.
  • Other ophthalmologists and industry leaders have chosen AGEI throughout the U.S. for their vision care.

 

Assil Gaur Eye Institute team of ophthalmological surgeons is conveniently located for patients throughout Southern California and the Los Angeles area with clinics in Beverly Hills and Santa Monica, and close to West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and all of Los Angeles.

 

Refractive lens FAQs

Is refractive lens exchange (RLE) covered by insurance?

NO. RLE is considered an elective procedure, as it is usually performed to correct refractive errors such as nearsightedness, farsightedness, or presbyopia rather than to treat a medical condition. Therefore, many insurance plans may not cover the cost of RLE. If you feel your insurance may cover some or all of the procedure, we will gladly provide you with the documentation to file directly. 

 

However, RLE may be considered medically necessary in some cases if the patient has a severe refractive error that cannot be corrected with glasses or contact lenses.

How successful is RLE (refractive lens exchange)?

RLE is considered a safe and effective outpatient procedure for correcting refractive errors. According to a study published in the Journal of Cataract and Refractive Surgery, RLE has a success rate of over 95%, with most patients experiencing significant improvement in their vision and reduced dependence on glasses or contact lenses.

Can refractive lens exchange be reversed?

No. Refractive lens exchange is a permanent surgical procedure. Once your eye’s natural lens is removed, you should have an intraocular lens (IOL) that remains in the eye permanently. But they can be easily replaced.

How long does refractive lens exchange last?

RLE is typically permanent, and the artificial lens inserted during the procedure can physically last a lifetime. However, your eye will continue to age, so other aging effects are possible and probable.

 

So some patients may elect to replace their old RLE with a new one that corrects their vision again. Or they may wear eyeglasses to, for example, help with their reading vision.

Can refractive lens exchange correct high astigmatism?

Refractive lens exchange can be an effective treatment option for correcting high astigmatism. 

 

However, the effectiveness of RLE for correcting high astigmatism depends on several factors, including the severity of astigmatism, the thickness and stability of the cornea, and the patient's overall eye health. 

How soon can I see well after refractive lens exchange? 

After refractive lens exchange (RLE), it is common to experience blurry vision and discomfort immediately following the procedure. However, many patients notice an improvement in their vision within a few days to a week after surgery.

 

The speed you can see well after RLE depends on several factors, including the individual healing process, the extent of the corrected refractive error, and your compliance. In some cases, patients may notice a significant improvement in their vision within the first few hours after the procedure.

How is RLE performed at AGEI? 

The LensAR laser makes a 2mm incision on the cornea (clear part) near the outer border of your iris. A pen-shaped instrument is inserted through this opening, emitting energy that breaks up your natural clear lens for removal. 

 

The bits are then gently vacuumed out of your lens capsule, and another pen-like instrument inserts the new IOL into your eye. 

 

Next, our femtosecond laser precisely positions the new lens into your natural lens capsule to ensure the right fit.

 

At AGEI, we use the ORA System™. This breakthrough technology allows your doctor to take a picture of your eye DURING SURGERY to verify that your nearsightedness, farsightedness, or astigmatism (your eyeglass prescription) was corrected and that the correctly powered lens has been selected.

 

Once the lens is in place, you're all set. Because we work through a 2mm incision, there is no need for stitches. Your cornea will heal the tiny wound on its own within 72 hours. Following your eye surgery, you will be sent home with antibiotic eye drops to prevent infection and other drops for post-op swelling and discomfort.

Are there risks or complications associated with RLE? 

Refractive lens exchange (RLE) is generally considered a safe procedure. However, it carries risks and potential complications like any surgical intervention. 

 

Common risks associated with refractive lens exchange include infection, hemorrhage, retinal detachment (people with high myopia are at the most significant risk), inflammation, glare, or halos.

 

  • Dr. Kerry Assil, Beverly Hills LASIK and Cataract Surgeon

    Kerry K. Assil, MD, is regarded as one of the world’s foremost experts in refractive surgery, having made significant advances in the field with his numerous inventions. Additionally he has the unique distinction of having trained thousands of eye surgeons in the latest refractive surgical techniques.

     

    Dr. Assil has authored more than one hundred textbooks, textbook chapters and articles on refractive surgery and has appeared regularly on major television network news programs as a pioneer in refractive surgery. He also leads educational forums for other eye care professionals, which have included featured lectureships at Harvard University, Johns Hopkins University and Tokyo University.

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