Refractive lens exchange, also called lens replacement surgery or clear lens extraction, may be a better option than LASIK, PRK 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 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.

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. 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 surgeon, Dr. Gregory Scimeca, 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. Initial recovery from refractive lens exchange — when you can resume normal everyday activities — usually takes about a week.

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. Also, since the lens is situated inside your eye and not on the surface like a contact lens, it is not visible to the naked eye. The artificial intraocular lens is a permanent replacement for your natural lens and is designed to last the rest of your life. And, because IOLs are not affected by age-related changes (i.e. cataracts) there is minimal risk of regression (loss of corrective effect or deterioration of vision) over time.

RLE and the Elimination of Cataracts

People who are middle-aged or older may have the beginnings of cataracts that eventually could worsen and require cataract surgery. If you have early cataracts, you could choose to have lens replacement surgery instead of waiting for the cataracts to progress to the point where they cause vision loss and have to be removed.

An added benefit of clear lens extraction is that it eliminates the risk of cataracts, because the eye's natural lens is replaced with an artificial lens implant.

Refractive Lens Exchange Vs. LASIK for Severe Refractive Errors

While LASIK remains the most popular option for correcting myopia and hyperopia, if you have a very severe refractive error or an abnormal cornea, lens-based refractive surgery such as clear lens extraction or phakic IOL implantation may be a better alternative.

Unlike LASIK or PRK, refractive lens exchange can correct almost any degree of hyperopia, and visual acuity after RLE surgery often is better than LASIK and PRK outcomes in cases of moderate and high hyperopia

The Alcon AcrySof IQ ReSTOR, Abbott Medical Optics ReZoom and Tecnis, and Bausch + Lomb Crystalens are three presbyopia-correcting intraocular lenses with FDA approval.

To schedule a consultation for Refractive Lens Exchange, please contact us.