Refractive Lens Exchange

Refractive lens exchange (RLE), also known as clear lens extraction (CLE), is a surgical procedure for vision correction that replaces the natural lens of the eye with an artificial intraocular lens (IOL). Using the same surgical techniques as cataract surgery, RLE is an alternative to laser vision correction, which modifies the cornea.

Patients who choose RLE have several options when it comes to the type of IOL that will be implanted. RLE is able to treat most types of visual disorders, including farsightedness, nearsightedness, presbyopia and astigmatism.

Candidates for Refractive Lens Exchange

Candidates for RLE meet the following criteria:

  • Want to reduce/eliminate dependence on corrective lenses
  • Are between 45 and 75 years of age
  • Have high myopia (advanced nearsightedness)
  • Have high hyperopia (advanced farsightedness)
  • Have presbyopia or astigmatism, with or without cataracts
  • Have early symptoms of cataracts
  • Are poor candidates for LASIK or PRK
  • Have no other health conditions that affect the eyes

Patients with astigmatism can have additional corrections, known as Limbal Relaxing Incisions, during their procedures. These incisions create a symmetrical cornea, helping to reduce or even eliminate astigmatism in the affected eye. Alternatively, there are IOLs that can correct some astigmatism.

Benefits of Refractive Lens Exchange

For some individuals, RLE has several advantages over other vision-correcting surgeries. It is of particular benefit to patients for whom laser surgery is not appropriate, such as those with advanced hyperopia and/or presbyopia. In fact, for such patients, RLE is often the only reliable alternative to wearing corrective lenses. RLE also has the advantage of offering patients a much shorter recovery period than laser procedures. And for those who are beginning to develop cataracts, RLE is the only way of preventing them from growing.

The Refractive Lens Exchange Procedure

RLE is performed, using the same techniques as those employed during cataract surgery, on an outpatient basis. A topical or local anesthesia is administered to minimize discomfort. Through a single tiny incision, the natural lens of the eye is removed, and replaced with an IOL. As in cataract surgery, there are several types of IOLs, including the following, to choose from:

  • Monofocal fixed-focus IOLs
  • Multifocal IOLs
  • Accommodating IOLs

Once inserted, the lens is unfolded and moved into its permanent position in the eye. There are no stitches needed because the incision seals on its own. RLE takes just 20 minutes to perform, and offers significant and immediate results. Recovery is usually complete after 4 weeks, whereas recovery from laser procedures can take 6 months.

Risks of Refractive Lens Exchange

Although RLE is considered a safe procedure, any surgery involves some risks. In the case of refractive lens exchange, there is a slight chance of retinal detachment, ocular hypertension, infection or inside-the-eye bleeding. In rare instances, patients may experience halos, blurred vision or droopy eyelids (ptosis).

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