Refractive Lens Exchange (RLE), also called Clear Lens Extraction, is a procedure that involves replacing the eye’s natural lens with an Intraocular Lens (IOL) as an alternative to laser vision correction. It can correct pre-existing nearsightedness, farsightedness, astigmatism and presbyopia. Presbyopia is a progressive condition typically requiring individuals over the age of 40 to become dependent on glasses for near vision. Over 3 million eyes each year in the United States received IOLs when undergoing cataract surgery which uses the same highly-successful surgical techniques used in RLE. RLE may be the procedure of choice for patients who are too nearsighted, too farsighted or have corneas that are too thin for laser vision correction. It may also be a viable alternative for those over the age of 40 who wish to eliminate their dependence on bifocals or reading glasses and for those individuals who may be showing early signs of developing cataracts. There are three anatomical factors that contribute to how well the eye can focus: the curvature of the cornea, the power of the eye’s internal natural lens, and the length of the eye. Vision correction procedures, such as LASIK or Advanced Surface Ablation (PRK) change the focusing power of the eye by changing the curvature of the cornea. RLE, on the other hand, changes the focusing power of the eye with an IOL of the appropriate power which is determined by the length of the eye and its corneal curvature. 

Exciting advances in intraocular lens design allow patients the option to choose a Monofocal, Multifocal, Accommodating, Extended Depth of Focus or Toric IOL to correct their vision. Monofocal IOLs correct nearsightedness and farsightedness, and provide excellent vision at one point of focus, usually distance. Monofocal IOLs can also be used to provide “monovision” or “blended vision,” where one eye is corrected for distance and the other eye corrected for either intermediate or near. In contrast to Monofocal IOLs, Multifocal, Accommodating, and Extended Depth of Focus IOLs (known as Presbyopia-Correcting IOLs) can provide a full range of clearer vision at multiple distances: near, intermediate, and distant, thereby allowing a person to perform most of their daily activities with reduced or no dependence on glasses.

Astigmatism is often present along with nearsightedness and farsightedness. It occurs when the cornea is shaped like a football, more curved in one direction than the other. This causes images to focus at multiple points on the retina, thereby creating blurry vision at all distances.

Small amounts of astigmatism can be treated with Limbal Relaxing Incisions (LRIs) to make the cornea more spherical. Higher amounts of astigmatism can be treated with a Toric IOL. Monofocal, Multifocal, Accommodating and Extended Depth of Focus IOLs are also available with a Toric lens component.

RLE is usually performed as an outpatient procedure in an ambulatory surgery center. The primary difference between cataract surgery and RLE is that cataract surgery is performed to remove a patient’s cloudy lens, while RLE is performed to reduce one’s dependence on glasses or contact lenses.

The eye is anesthetized to ensure patient comfort during the procedure. Today’s modern surgical techniques allow surgeons to remove the natural lens from the eye using ultrasonic vibrations through a microincision of 3mm or less. The natural lens is replaced by the intraocular lens, which is inserted through the microincision. Once inside the eye, the lens spontaneously unfolds as it is placed into its permanent position. Usually, no sutures are required.

Patients go home soon after the procedure to relax for the rest of the day. Everyone heals somewhat differently, but many patients report improvement in their vision almost immediately, and most resume their normal activities within a day or two. RLE is usually performed on the second eye a week to several weeks after the first procedure. Your vision will continue to improve over time as your brain adapts to your new intraocular lenses. Once stable, your vision is unlikely to change over time. In fact, patients having RLE will avoid the need for cataract surgery later in life.