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Refractive lens exchange (RLE) is essentially a variation of cataract surgery. Cataract surgery is one of the most common and safest surgeries in the United States.
With new advances in technology, we have been able to take the excellent track record of cataract surgery and apply these same principles to vision correction. Over the next ten years, lens implant surgery is predicted by some of the leading experts in the field to become one of the dominant forms of vision correction surgery.
The surgery is performed under a microscope. This provides your doctor with a magnified view of the eye’s interior. Our cataract specialists perform the latest no-stitch, no-patch, clear corneal technique, under topical anesthesia, with phacoemulsification and intraocular lens implantation.
They have performed over 40,000 surgical cases and has over 40 years of combined experience.
Your risk of having a surgical complication during intraocular lens surgery (IOL) performed by either of our doctors is 75% less than the average intraoperative complication rate for the same procedure performed in the United States. Experience does make a difference!!
Traditionally, lenses used in cataract surgery have been monofocal, allowing the user to see well at a single distance. Patients with monofocal lenses usually choose to have their natural lenses replaced with lenses that allow them to see well at distance and wear reading glasses for up close or intermediate work. Recent advancements in lens technology, however, have resulted in the development of multifocal and accommodating lens implants.
These new style lenses allow the patient to focus at different distances, giving good distance vision, plus improvement in intermediate or near vision. RLE can minimize your dependence on reading glasses or bifocals, but even with the newer multi-focal or accommodating lenses, glasses may be needed in certain situations. 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, All-Laser Lasik, PRK, LASEK, Epi-Lasik if the patient is presbyopic.
In RLE the natural lens of the eye is removed and replaced with a silicone or medical grade polymer 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, conventional or custom wavefront Lasik, LRIs, All-Laser Lasik, PRK, LASEK, CK, or Epi-Lasik may be required in addition to 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, All-Laser Lasik, 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.
One disadvantage with RLE is that it is a significantly more invasive surgery than any cornea-based refractive surgery or even phakic IOLs. An extremely myopic patient would have an elevated risk of vitreous or retina problems after RLE which is why we are hesitant to offer this procedure to this population.
If you have accommodation, you will loose all of you accommodation and is why we only recommend the procedure in presbyopic patients . If you are already fully presbyopic and need powerful reading glasses or bifocals, the reduction of accommodation with RLE may not be a problem because you already have a very limited range of accommodation.
One disadvantage with RLE is that it is a significantly more invasive surgery than any cornea-based refractive surgery or even phakic IOLs. An extremely myopic patient would have an elevated risk of vitreous or retina problems after RLE which is why we are hesitant to offer this procedure to this population
Most IOLs 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 limited range of accommodation. You may also have a multifocal IOLs such as the ReSTOR 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.