Refractive Lens Exchange

Text size:
Last updated 10/8/2019
Reflective Lens exchange, Assil Eye Institute Los Angeles

What is refractive lens exchange?

Refractive Lens Exchange (or RLE), is a surgical procedure that involves replacing your eye's natural lens with an artificial lens that improves the way that light is focused on your retina.

 

Essentially, RLE is when a "permanent contact lens" is placed in your eye so you have great vision whenever you open your eyes without the need for contact lenses or glasses.

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 considering.

 

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 begins after age 40).

 

RLE vs. cataract surgery

RLE surgery and cataract surgery are exactly the same operation. 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?

AEI 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 at 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 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 AEI, 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 uses 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 a safer surgery and promotes faster visual recovery.
  • AEI 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.
  • AEI 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.

 

  • 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.

1256 Total 1st Party Reviews
4.9 out of 5 Stars
  • GatherUp
    Dr P thoroughly answered all my questions.
    Paul B.
  • GatherUp
    On Oct. 16, 2019, I had my eyes examined by Dr. Gaur and Stacy. They both did a very thorough job. They also gave me important ...
    John S.
  • GatherUp
    Very professional staff and office!
    Tola M.
  • GatherUp
    The staff took care of me well. Everybody was friendly.
    Sheri J.
  • GatherUp
    Is it time for my eye procedures as my current glasses are being less effective at doing my job correctly. Keep up the great wo...
    Steven V.
  • GatherUp
    Check in was great the gentleman that did my preliminary tests was awesome and very professional
    Todd P.
  • GatherUp
    Punctual, thorough, informative and professional
    Ronald S.
  • GatherUp
    Great experience so far
    Ricardo H.
  • GatherUp
    Good services
    Am V.
  • GatherUp
    Dr. Assil and his team are always wonderful and getting straight to the point of the matter and this is so appreciated. Always ...
    Michelle S.
Look Who Trusts Their Eyes to Assil Eye Institute...
  • LeBron James
    Los Angeles Lakers

    LeBron James is one of the NBA's greatest of all time. He absolutely depends on his vision to perform at the very highest level.

     

    LeBron trusts his eyes to Assil Eye Institute.

  • Anthony Davis
    Los Angeles Lakers
  • Chris Paul
    Oklahoma City Thunder
  • Dwyane Wade
    Miami Heat (retired)
  • Marlee Matlin
    Actress
  • Michelle Williams
    Actress
  • LaToya Jackson
    Entertainer
  • Lorenzo Lamas
    Actor
  • Philip Bailey
    Earth Wind and Fire
  • Gary Sinise
    Actor
  • Rip Hamilton
    Former NBA player
  • John Salley
    Commentator, former NBA player
  • Blair Underwood
    Actor
  • Tom Arnold
    Comedian/Actor
  • Troy Evans
    Actor
  • John Noble
    Actor
  • Isaac Eddy
    Actor/Director/Teacher
  • Barbara Rush
    Actress
  • John Emerson
    US Ambassador to Germany
  • Shane Mosley
    Former professional boxer
  • Cuttino Mobley
    Former NBA player
  • Seth Gordon
    Director
  • Maurice Evans
    Former NBA player
  • Wang Luoyong
    Actor
  • Jesse Metcalfe
    Actor
  • Ananda Lewis
    Television Personality
  • Rob Brydon
    Comedian
  • Clifton Collins Jr.
    Actor
  • Malinda Williams
    Actress
  • Adrienne Frantz
    Actress
  • Lacey Chabert
    Actress
  • Brad Pitt
    Actor
  • LeBron James
    Los Angeles Lakers
  • Anthony Davis
    Los Angeles Lakers
  • Chris Paul
    Oklahoma City Thunder
  • Courtney Cox
    Actress
  • Paul George
    Los Angeles Clippers
  • Dwyane Wade
    Miami Heat (retired)
  • Marlee Matlin
    Actress
  • Michelle Williams
    Actress
  • Jalen Brunson
    Dallas Mavericks
  • Mychal Thompson
    Commentator, former NBA player
  • LaToya Jackson
    Entertainer
  • Lorenzo Lamas
    Actor
  • Philip Bailey
    Earth Wind and Fire
  • Gary Sinise
    Actor
  • Rip Hamilton
    Former NBA player
  • John Salley
    Commentator, former NBA player
  • Blair Underwood
    Actor
  • Tom Arnold
    Comedian/Actor
  • Troy Evans
    Actor
  • John Noble
    Actor
  • Isaac Eddy
    Actor/Director/Teacher
  • Barbara Rush
    Actress
  • Rudy Garciduenas
    Blue Man Group
  • John Emerson
    US Ambassador to Germany
  • Shane Mosley
    Former professional boxer
  • Cuttino Mobley
    Former NBA player
  • Seth Gordon
    Director
  • Maurice Evans
    Former NBA player
  • Cheri Blauwet
    Physician and Wheelchair Racer
  • Wang Luoyong
    Actor
  • Jesse Metcalfe
    Actor
  • Jeana Wilson
    Actress
  • Courtnee Draper
    Actress
  • Ananda Lewis
    Television Personality
  • Robyn Johnson
    Producer
  • Rob Brydon
    Comedian
  • Cary Schuman
    Actor
  • Roland Buddy Lewis Jr.
    Comedian
  • Clifton Collins Jr.
    Actor
  • Malinda Williams
    Actress
  • Chad Jeffers
    Musician
  • Adrienne Frantz
    Actress
  • Franco Carlotto
    Body Builder
  • Brad Mates
    Musician
  • David Pichette
    Musician
  • Mike Melacon
    Professional Baseball Player
  • Nautica de la Cruz
    Radio Personality
  • Lynn Conkwright
    Body Builder
  • Nely Galan
    Producer
  • Roxanne Galla
    Actress
  • Lacey Chabert
    Actress