Refractive Lens Exchange

Who is a good candidate for Refractive Lens Exchange?

If you've been told that you're not a candidate for LASIK or PRK laser vision correction but you wish to eliminate your dependency on glasses or contact lenses, RLE might be with consideration.

Refractive Lens Exchange is a good option for people who are very nearsighted (distant objects appear blurry) or farsighted (close objects appear blurry). It's also good for people starting to develop cataracts, and those who are presbyopic (who suffer from a gradual decline in the ability to focus on close objects that begin after age 40).

RLE vs. cataract surgery

RLE surgery and cataract surgery are exactly the same operations. Both remove your eye's natural lens through a small incision and exchange it for a new lens that is intended to be permanent. The difference between these two surgeries is that RLE is a refractive procedure. In other words, it corrects your vision prescription instead of inserting a clear lens in your eye, as is the case during cataract surgery.

With standard cataract surgery, your natural lens is exchanged for a crystalline clear lens. But with Refractive Lens Exchange surgery, you are fitted with a lens implant that corrects the refractive error in your eye, whether it's nearsightedness (myopia) farsightedness (hyperopia) or both. Think of it as having a tiny lens with your eyeglass prescription implanted in your eye.

Unlike LASIK or PRK, refractive lens exchange can correct almost any degree of hyperopia. This means that RLE is a better option than LASIK and PRK for achieving better results in patients with moderate and high hyperopia or myopia.

Today, there are premium multifocal intraocular lenses (IOL for short) that not only correct for near and distance vision, but also can correct astigmatism.

The variety of IOLs available today allows you and your eye surgeon to select the lens type and combination that works best for you. Some patients select a lens for near vision in one eye and far vision in the other, much like patients who wear monovision contact lenses.

What are my IOL options?

AGEI offers a wide range of IOL options to fit a broad spectrum of patients. Such as:

Monofocal IOL

Monofocal IOLs are the most commonly used lenses for RLE. Unlike your natural lens, which can stretch or bend to help your eye focus at varying distances, this lens focuses on a fixed distance. Patients who are comfortable with their reading glasses may prefer to have single-vision lenses. This will give them crisp, clear distance vision, much like when they were young, but they will still need their reading glasses for near vision.

Multifocal IOL

Multifocal IOLs offer patients the possibility of seeing objects at a distance AND close up. Just like glasses with bifocal or progressive lenses, this lens has different zones that help you see things at various distances. This presbyopia-correcting lens takes some time to get used to because your brain needs to adapt to looking through the different lens zones so that your vision feels natural.

Accommodating IOL

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

Toric IOL

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

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

How is RLE performed?

Refractive lens exchange is a quick procedure performed using anesthetic eye drops and you are able to go home straight after surgery. The surgery is virtually painless, involves no bleeding, and typically uses no sutures (stitches).

The procedure is done in our surgery suite. After you are positioned comfortably, your doctor places the anesthetic eye drops into your eye. If you feel that you need it, you can be given medicine by mouth to help you relax. The surgery takes five to seven minutes per eye and is not painful. All that you will feel is mild pressure during the procedure.

The LensAR makes a 2mm incision on the cornea (clear part) near the outer border of your iris. A pen-shaped instrument is then inserted through this opening and emits energy that breaks up your natural iris into fragments.

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.

Proper lens placement is critical to achieving the best visual outcome when placing a multi-focal IOL in order to take full advantage of the lens design to achieve optimal vision at all distances.

At AGEI, we use the ORA SystemTM, a breakthrough technology, that 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.

We also use ¨cold¨ ultrasound during surgery in order to minimize eye swelling. This results in a safer, more efficient lens replacement surgery and a faster visual recovery.

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, as well as other drops for post-op swelling and discomfort.

What to expect after RLE surgery

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

You will follow up with your eye doctor on the day after surgery and then one week later, to keep a close watch on your healing progress. You can expect to return to your daily routine within a few days and can go back to driving one week after surgery. You will be cautioned to avoid strenuous exercise and heavy lifting. Your eye will be fully stable in about eight weeks

Are there risks or complications associated with RLE?

All surgeries have a risk of complications, no matter how small that risk may be. That said, it's important to review the risks associated with IOL implantation so that you can make an informed decision as to what is right for you.

The most serious risks associated with RLE surgery include:

• Infection
• Hemorrhage
• Risk of Retinal detachment (people with high myopia are at the greatest risk)
• Intraocular lens dislocation
• Inflammation of the cornea or macula
• Ptosis (droopy eyelid)
• Glaucoma from increased eye pressure
• Glare or halos
• Haze developing behind your new lens (called Posterior capsule opacification, this is treated with a simple office procedure called a YAG capsulotomy)

Why get refractive lens exchange done at AEI

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

Our surgical approach was developed by Dr. Assil, one of the pioneers of laser lens implantation surgery. He has been involved in the development and clinical testing of a number of premium intraocular lenses. What's more, Dr. Assil was the first eye surgeon in the United States to use the ORA System for intraoperative vision testing during lens implantation.

Here are some of the steps we take to marry the most advanced technology available today with a meticulous surgical approach designed to make your refractive surgery safer, your visual recovery faster, and your post-op vision acuity the best possible:

• We prepare for your surgery by putting you through a battery of pre-operative tests, using various state of the art measuring systems, to precisely measure your eye power and your intraocular lens size.
• At AEI we use the LensARTM Femtosecond laser, the most precise laser available today, to accurately define the shape and size of your natural lens. The LensARTM does so using detailed algorithms to calculate exact measurements. This algorithm approach differs from a “one size fits most” methodology commonly used by eye surgeons that use mathematical averages to determine your lens size and shape. This is important because the ability to exactly calculate your natural lens size makes the LensAR the safest option for natural lens extraction.
• We use a microsurgical approach and perform your lens exchange surgery through a 2mm incision. This allows for faster healing and vision recovery.
• We use “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.
• AGEI has been chosen by other ophthalmologists and industry leaders throughout the U.S. for their vision correction as well as for the eye care of their families.

Refractive lens FAQs

Is refractive lens exchange (RLE) covered by insurance?

RLE is typically considered an elective or cosmetic procedure, as it is usually performed to correct refractive errors such as nearsightedness, farsightedness, or presbyopia rather than to treat a medical condition. As such, many insurance plans may not cover the cost of RLE.

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

How successful is RLE (refractive lens exchange)?

RLE is considered a safe and effective 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?

Refractive lens exchange is a permanent surgical procedure. Once the natural lens is removed, it cannot be replaced, and the intraocular lens (IOL) remains in the eye permanently.

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 long does refractive lens exchange last?

The effects of RLE are typically permanent, and the artificial lens inserted during the procedure should last a lifetime. However, the longevity of the lens may depend on several factors, such as the patient's age, lifestyle, and health condition.

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 and the extent of the corrected refractive error. In some cases, patients may notice a significant improvement in their vision within the first few hours after the procedure.