ProceduresRefractive Lens Exchange (RLE)

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Last updated 10/8/2019
Dr. Assil discussing refractive lens exchange surgery

What's 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.

 

Who's a good candidate for refractive lens exchange?

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

 

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

 

What is the difference between RLE and 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 you have 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, and visual acuity after RLE surgery often a better option than LASIK and PRK outcomes in cases of moderate and high hyperopia or myopia. There are new premium multifocal lenses that even correct astigmatism.


The variety of intraocular lens (IOLs) available today allows you and your doctor 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.

 

 

Different types of intraocular lens (IOLs)

AEI has a wide range of IOL options to fit a broad spectrum of patients. Such as:

 

Monofocal IOL

Monofocal IOL are the most commonly used lens 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

 

Multifocal IOL

Multifocal IOL offers 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 zones so that your vision feels natural.

 

Accommodating IOL

Accommodating IOL is a flexible IOL that acts more like your natural lens and can focus at more than one distance. This IOL makes 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, this can make your vision blurry all over, not just close up or far away. This lens lessens astigmatism, so you won't need glasses to correct it after your surgery.

 

Of course, our surgeons will discuss which lens option is right for you.

 

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.


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 also be given medicine by mouth to help you relax. The surgery takes five to seven minutes per eye and is not painful. You will only feel mild pressure during the procedure.


The LensAR then 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, the 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 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 can I 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 any 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 performed at AEI?

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


In fact, 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.
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