Refractive Lens Exchange

Refractive Lens Exchange (RLE) is essentially cataract surgery, but exclusively for refractive purposes. RLE is sometimes called Clear Lens Exchange (CLE), Clear Lens Extraction (CLE), and Refractive Lens Replacement (RLR). RLE is often an appropriate alternative to conventional or wavefront LASIK, IntraLasik, PRK, LASEK, Epi-Lasik if the patient is presbyopic.

Exchange The Natural Lens

In RLE the natural lens of the eye is removed and replaced with a silicone or plastic intraocular lens (IOL). The replacement IOL is of a power to correct most, if not all, of the patient’s hyperopia or myopia. RLE alone is not very successful at correcting astigmatism. To correct astigmatism, corneal relaxing incisions, conventional or custom wavefront Lasik, IntraLasik, PRK, LASEK, CK, or Epi-Lasik may be required in addition to RLE.

Advantages of RLE

There are several advantages to RLE over other forms of refractive surgery. Some of the most obvious are that the surgery has years of successful history and the cornea is relatively untouched. If you have a thin cornea, dry eyes, or other minor cornea problems, RLE may be a better alternative. RLE may be the only option for people with high refractive error. Also, if the exact desired refractive change is not achieved, the IOL may be exchanged for one of a different power, or a cornea-based refractive surgery technique such as conventional or custom wavefront Lasik, IntraLasik, PRK, LASEK, CK, or Epi-Lasik may be used in combination with RLE to “fine tune” the correction. Because RLE removes the natural lens, there is no possibility of developing a cataract in the future. In patients over 55 or so, this may be the better option since everyone develops a cataract with age. Determining intraocular lens power in an eye that has not had corneal surgery is much more accurate than after such surgery is performed.

Disadvantages of RLE

A big disadvantage with RLE is that it is a significantly more invasive surgery than any cornea-based refractive surgery. An extremely myopic patient would have an elevated risk of vitreous or retina problems after RLE.

If you have accommodation (the ability to focus at near while wearing your distance correction), you will loose some or all accommodation. If you are already fully presbyopic and need powerful reading glasses or bifocals/progressives, the reduction of accommodation with RLE may not be a problem because you already have a very limited range of accommodation. Everyone loses accommodation starting in their early to mid forties.

See Distant and Near

Most intraocular lenses cannot accommodate by changing focus from distance to near like a young and healthy natural lens. Your eye will be set to either near vision or far vision. New accommodating IOL designs such as the Crystalens do have the ability to provide a range of accommodation. You may also have multifocal IOLs such as the ReSTOR and the ReZoom implanted that help with near and distance vision. You will need to discuss with your doctor if a multifocal or accommodating IOL is appropriate for your circumstances. It is possible to be corrected for monovision with RLE. Monovision is another method to receive some advantage of near and distant vision and resolve presbyopia.

If you already have cataracts starting to form, RLE may make a lot of sense. If you are already presbyopic, RLE may be a better alternative. There is little need to have surgery affecting the cornea if within a short period of time you will be having cataract surgery anyway or you already cannot change focus from distance to near.

Perhaps A Cataract Surgeon, Not Lasik Surgeon

Something important to note is that RLE is often not performed by refractive surgeons who specialize only in cornea based conventional or custom wavefront Lasik, IntraLasik, LASEK, PRK, Epi-Lasik, and CK. RLE is very different from these procedures. For this reason, a Lasik doctor may not even mention RLE, let alone provide it. For successful RLE, you may find it necessary to locate a good cataract doctor or select a doctor who has both extensive cataract experience and extensive cornea-based refractive surgery experience.

If you are ready to choose a physician, you should have all the options available. At Precision Eye Care, the physicians will help you decide which procedure may be right for you. If you are not a good candidate for current technology, you will be informed of that and notified when procedures that might be right for you become available.