Refractive lens exchange, also called lens replacement surgery or clear lens extraction, may be a better option than LASIKPRK or phakic IOL refractive surgery for people with presbyopia and high hyperopia (farsightedness). Refractive lens exchange (RLE) replaces your eye’s clear natural lens with an artificial intraocular lens (IOL) to correct your refractive error and achieve sharper focus, reducing your need for reading glasses or bifocals. refractive lens   Refractive lens exchange typically is for people with presbyopia or extreme farsightedness, for whom LASIK, PRK or phakic IOL surgery generally are not suitable. If you have both presbyopia and moderate to severe hyperopia, RLE may be the only viable option for clear vision and minimal reliance on glasses after refractive surgery with Lens replacement surgery also can correct myopia (nearsightedness), but generally, it is not recommended when LASIK, PRK or phakic IOLs are available. The procedure for refractive lens exchange is virtually identical to cataract surgery with the home cleaning service. The difference is that in RLE, the lens being replaced is clear, rather than a cloudy lens due to a cataract. As in cataract surgery, three types of IOLs are available to replace your natural lens, depending on your vision needs and the health of your eyes. They are:
  • Monofocal fixed-focus IOLs. Monofocal lenses provide clear vision at distance, intermediate or near ranges — but not all three at once. Toric IOLs to correct astigmatism also are classified as monofocal IOLs.
  • Multifocal IOLs. A multifocal lens provides clear vision at multiple distances.
  • Accommodating IOLs. An accommodating IOL is a type of monofocal lens that enables focus at multiple distances by shifting its position in the eye.
With intraocular lenses, there is no “one size fits all,” and your eye surgeon will recommend an IOL that is most suitable for your individual needs.  

Refractive Lens Exchange: The Procedure

  Lens replacement surgery usually takes about 15 minutes and is performed on an outpatient basis. Each eye is done separately, usually about a week apart. Numbing anaesthetic drops are used during RLE, so typically there is no discomfort, and most people report immediate vision improvement after surgery. Initial recovery from refractive lens exchange — when you can resume normal everyday activities — usually takes about a week. Final outcomes of refractive lens exchange can take up to several weeks, and you may notice vision disturbances such as blurry vision, halos and glare, or a “scratchy” sensation as your eyes heal. You should be able to return to work and resume driving within a week of surgery, dependent on your eye surgeon’s instructions. Normally, you won’t feel an IOL in your eye, in the same way, that you don’t feel a dental filling for a cavity. And since the lens implant is inside your eye and not on the surface like a contact lens, it’s not visible to others. The artificial intraocular lens is a permanent replacement for your natural lens and is designed to last the rest of your life. Also, there is minimal risk of regression (loss of corrective effect or deterioration of vision) over time.  

Vision After Refractive Lens Exchange

  Whether you will need eyeglasses or contact lenses after refractive lens exchange depends on the type of intraocular lens used. Monofocal IOLs have been used extensively in cataract surgery and clear lens exchange. They offer excellent vision and contrast sensitivity and have low instances of vision disturbances such as halos and glare. However, because monofocals are designed to focus only at one distance, you will likely need glasses for up-close tasks such as reading the fine print and working at a computer (but monovision can help with your near vision). Generally, if you need glasses after RLE, you will see more clearly and comfortably if the anti-reflective coating is added to the lenses to eliminate distracting reflections. (This is true for reading glasses and computer glasses as well as glasses worn full time for residual refractive errors.)Also, if you are bothered by glare from bright light after refractive lens exchange, consider photochromic lenses that automatically adjust to changing light conditions outdoors.  Your eye surgeon will advise on the most suitable IOL for you.