Lens Replacement Surgery

Types of Lens Replacement Surgeries

Lens replacement surgery is a general term for procedures that enhance visual acuity (ability to see clearly).

They address refractive errors such as severe farsightedness, nearsightedness, astigmatism, and presbyopia (age-related farsightedness).

The most popular lens replacement procedures include:

• Refractive lens exchange (RLE)
• Cataract surgery

RLE and cataract surgery involve the removal of the natural eye lens and replacement with an artificial one designed to improve vision. 

These eye surgeries have the same goal — to improve vision and reduce or eliminate the need for glasses or contact lenses.

Another notable lens implant procedure is intracameral lens, also known as implantable collamer lens (ICL).¹

ICL does not involve the removal of the natural lens. However, it also offers a permanent solution for vision correction.  

Below is a detailed summary of the above procedures:

Refractive Lens Exchange (RLE)

RLE is an outpatient procedure performed in a clinic or doctor’s office.

The procedure is similar to cataract surgery — it replaces a natural lens with an artificial one that corrects existing refractive errors.

Eye doctors recommend RLE to treat severe cases of myopia (nearsightedness), hyperopia (farsightedness), and presbyopia (age-related farsightedness). 

One advantage of RLE is that it prevents cataracts (clouding of the natural eye lenses).

The procedure also eliminates contact lens risks such as:²  

• Dry eyes
• Red eyes
• Irritation
• Eye infections
• Accidental injuries such as corneal abrasions

RLE provides long-lasting clear vision because the artificial lenses do not degrade, and there’s no maintenance required.

The refractive lens exchange procedure is not reversible.

Candidacy

You may qualify for RLE if you:³

• Don’t qualify for LASIK eye surgery or photorefractive keratectomy (PRK)
• Wish to treat presbyopia (age-related farsightedness)
• Want to get rid of eyeglasses or contact lenses

Procedure 

Below is what to expect before, during and after surgery:

Before surgery:

Days before surgery, your surgeon will thoroughly examine your eyes to ensure RLE is the right procedure for you. 

If you’re eligible for the less invasive LASIK surgery, ICL, PRK, contacts, or eyeglasses, your surgeon may recommend these instead of RLE. 

They will also take eye measurements to determine the types of intraocular lenses (IOLs) that will restore your visual acuity.

If you wear contacts or eyeglasses, you’ll be required to avoid them for at least a week before your initial examination.

Doing this will allow your cornea and other eye structure to return to their natural shape. It also prevents measurement errors during the eye examination process.

Your doctor will also discuss the risks and expectations of the procedure. Be sure to raise any concerns you may have before the day of the surgery.

Your doctor may recommend steroid and antibiotic eye drops a day or two before the surgery to lower the risk of inflammation or infection.

During surgery:

On the day of the surgery, prepare reliable transportation to and from the doctor’s office.

Remember, your ability to operate machinery may be impaired due to the effects of sedation and mild discomfort after surgery. 

Before surgery, you’ll sit in a reclining chair. Your surgeon will administer anesthetic eye drops and mild sedatives. These will help ease discomfort and help you relax.

Your surgeon will then sterilize the skin around your eye and protect the area with a sterile cloth in preparation for the incision.

With your eyelids held open using an eyelid holder, your surgeon will make a small incision in your cornea.

Once the incision is made, they’ll use either an ultrasound or a femtosecond laser to fragment the natural eye lens for easy removal. Then the natural lens is replaced with an artificial one. 

There is no one-size-fits-all when it comes to artificial lenses. Your surgeon will choose the best option based on what will work best for your situation.

The different types of IOLs available include:⁴

Multifocal IOLs

These are designed to provide near, intermediate, and distant focus at the same time.

Monofocal IOLs

These are designed for either near, intermediate, or distant focus, but not all at the same time.

Accommodating IOLs

These are monofocal lenses but provide clear focus at different distances when you move your eyes.

Toric or astigmatism correction IOLs

These are premium monofocal lenses that help treat astigmatism. They cost more than standard monofocal lenses.

RLE is a painless and quick procedure that usually takes about 15 minutes. 

If you need IOLs in both eyes, your surgeon will treat both eyes separately (one to two weeks apart).

After surgery:

Immediately after refractive lens exchange surgery, you may experience mild discomfort, glares, halos, and blurred vision. These will go away as you heal.

Most people report clear vision immediately after the procedure. However, you’ll fully recover after several weeks.

Your surgeon may prescribe steroid, anti-inflammatory, and antibiotic drops to help prevent infections and inflammation.

They may also recommend an eye patch or protective eyeshield for a few days to prevent self-injury, especially during sleep.

Attend a follow-up appointment within 24-48 hours after surgery for close monitoring and regularly until you recover.

Also, make sure you follow your doctor’s post-op care instructions to avoid complications and promote healing. 

Cost

Refractive lens exchange is an elective and is therefore not covered by your private insurance or Medicare. 

The cost may vary depending on your location, available facilities, or your surgeon’s experience.

On average, RLE costs $2,500 to $4,500 per eye.

Cataract Surgery

Cataracts are common eye lens replacement surgery among older people (50 years or older).⁵ When you have cataracts, your clear eye lens hardens and appears cloudy. 

Severe cloudiness may affect your ability to see clearly, requiring cataract surgery.

Cataract surgery is an outpatient procedure that replaces your cloudy eye lens with a clear artificial intraocular lens.

Studies indicate about 28 million cataract surgeries are performed each year worldwide, with 4 million being in the United States alone.⁶

Cataract surgery is similar to refractive lens exchange (RLE). However, notable differences include the intention for surgery and expectations afterwards.

Cataract surgery aims to correct vision issues caused by cloudy natural eye lenses. 

On the other hand, RLE aims to restore perfect vision and eliminate the need for glasses or contact lenses.

Those who undergo cataract surgery are more likely to notice improved vision, but not perfect vision. They may need to continue using prescription glasses even after surgery.

If cataracts occur alongside presbyopia or age-related farsightedness, cataract surgery will correct both problems.

Candidacy

You may qualify for cataract surgery if you:

• Are over 50 years old and in the early stages of cataract development
• Have cloudy eye lenses that are affecting your vision
• Wish to reduce the need for contact lenses or eyeglasses
• Have cataracts that are affecting the outcome of other eye treatments, such as laser eye surgery

If you have cataracts and advanced eye problems such as macular degeneration or a detached retina, cataract surgery may not be effective.⁷

However, your doctor will determine your eligibility and risk potential during an initial eye exam.

Procedure 

Below is what to expect before, during, and after cataract surgery:

Before surgery:

While cataract surgery is considered safe, preparation is essential to ensure optimum results and avoid complications.

Before the surgery, your eye doctor will examine and measure your eyes using different tools. This will help them identify the appropriate IOLs for you.

Follow these general tips as you prepare for the surgery:

• Stop taking aspirin or anti-clotting drugs as these may interfere with normal bleeding
• Avoid wearing makeup such as mascara, eyeliners, or artificial eyelashes
• On the surgery day, wash your face with soap and water only
• Abstain from drinking alcohol at least 24 hours before surgery
• Avoid wearing contact lenses and prescription glasses a few days before surgery
• Set up your transportation to and from surgery (you may experience temporary vision impairment immediately after)

If you take prostate medication such as Flomax, tell your doctor since these alpha-blockers interfere with iris muscles during cataract surgery.

Like most eye surgeries, your doctor may recommend steroid and antibiotic eye drops a day or two before the surgery to prevent possible inflammation or infection.

After surgery:

Immediately after cataract surgery, you may experience some discomfort or blurry vision for a few days. 

Many recovering patients report clear vision within a few days after the surgery. 

However, each person heals differently, and you may need as long as a week or two before you see images in their sharpest focus.

Complete healing occurs within eight weeks after surgery. 

Sometimes, cloudiness may also occur after surgery, known as posterior capsule opacification. This occurs due to the thickening of the tissues holding the lenses. 

Posterior capsule opacification develops over several months or years after surgery.

To address this, your doctor will recommend a painless laser treatment known as YAG laser capsulotomy.⁸

Just like other eye surgeries, make a follow-up appointment at least 24 to 48 hours after for close monitoring of the healing process.

Studies on cataract surgery show a success rate of about 99%.⁹

Cost

On average, cataract surgery may cost around $3,500 to $3,900 per eye without insurance.

However, the price may vary based on your region, the available facilities, and the surgeon’s experience.

However, unlike RLE, cataract surgery is considered medically necessary and is covered by most insurance programs, including Medicare and Medicaid.

Depending on your insurance cover, you may have to pay out of pocket for things like deductibles, co-pay, and co-insurance.

Intracameral Lens (ICL)

Intracameral lens (ICL) or Visian ICL is the latest version of the phakic implants used to correct a wide range of myopia (nearsightedness) and astigmatism.¹⁰

RLE and cataract surgery involve the entire removal of the eye’s natural lens. ICL lenses, on the other hand, are placed behind the iris. This enhances the focusing ability of the existing natural lens.

The lens is intended for permanent use, but the procedure is reversible.

ICL lenses are quite different in shape, size, and consistency compared to standard contact lenses. 

Visian ICL is ideal for people who don’t qualify for laser refractive surgery. It’s also a preference for those at risk of dry eyes. 

Candidacy

You may qualify for ICL surgery if you:

• Are between 21 and 45 years old
• Aren’t a good LASIK surgery candidate 
• Have moderate to severe myopia (nearsightedness)
• Have minor to no astigmatism
• Have good general eye health 
• Have no history of eye trauma
• Do not take medications such as steroids that can interfere with healing
• Have at least six months to a year of unchanged vision correction prescriptions
• Aren’t pregnant or breastfeeding
• Aren’t allergic to local anesthetic eye drops

Procedure 

Below is what to expect before, during and after ICL surgery.

Before surgery:

Just like RLE and cataract surgery, preparation is important. Your doctor will examine your eyes to determine eligibility. 

They will also provide pre-surgery instructions to ensure you’re ready on the day of surgery.

During surgery:

You’ll sit in a reclining chair, and your surgeon will prepare your eyes for ICL. You’ll be sedated and your eye sterilized.

Your surgeon will make a small incision in your cornea. Then they’ll insert the ICL lens between your iris and natural lens to enhance your natural lens’s focus.

After surgery:

After the procedure, your surgeon will stitch up the incision to hold the lens in place. This procedure takes about 20 to 30 minutes.

Most people experience clearer vision immediately after surgery. You must follow your surgeon’s post-op care instructions to avoid complications.

Cost

The cost of ICL may vary based on your location, facility, and surgeon’s experience. ICL is also considered elective and, therefore, not covered by your insurance.

On average, the ICL procedure may cost about $4,000 to $5,000 or more per eye.

How Long Does it Take to Recover From Lens Replacement Surgery?

The recovery process may vary from patient to patient. However, the end result is the same—better vision.

If both eyes require surgery, the procedures are typically done on separate days, usually two weeks apart. This also affects the recovery timeline.

Notably, most patients will achieve clear vision immediately after ICL surgery. But this doesn’t indicate full recovery. 

Your vision will stabilize in about a week or two. At this point, you can resume normal activities like reading, watching TV, and driving, but in moderation.

Expect a full recovery in about eight weeks. Successful recovery will depend on your ability to care for your eye after surgery. 

Here are some post-op-care instructions to expect:

• Avoid rubbing your eyes for about 3 to 5 days
• Wear protective gear such as eyeshields or UV blocking sunglasses
• Avoid makeup, creams, and lotions for some time
• Avoid water contact (e.g., in swimming pools, rivers, oceans, or hot tubs)
• Stay away from strenuous activities such as heavy lifting and contact sports

Possible Side Effects 

• Temporary blurring
• Increases sensitivity to light
• Halos and glares around lights
• Mild discomfort

What are the Risks? 

• Retinal detachment, especially in extremely nearsighted people
• Dislocated IOL
• Increased eye pressure (ocular hypertension)
• Severe reddening of the eyes
• Infection or bleeding inside the eye
• Droopy eyelid (ptosis)¹¹
• Glare, halos, and blurry vision from multifocal IOLs

Lens Replacement Surgery vs. Other Treatments

Lens replacement surgery is more invasive than refractive eye surgeries such as LASIK and PRK. 

More risks are associated with these procedures, including a prolonged recovery timeline. However, the success rate is high (99%), with most people reporting satisfaction with their outcomes.

The risks are a worthwhile trade-off if you have high refractive errors and desire perfect vision.

Your ophthalmologist will most likely recommend lens replacement when other treatments are not suitable.