Refractive Lens Exchange (RLE)

7 sources cited
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What is Refractive Lens Exchange (RLE)?

Refractive lens exchange (RLE) is a type of surgery that corrects eyesight problems. 

During surgery, an ophthalmologist uses ultrasound to remove the natural eye lens. They then insert a replacement intraocular lens (IOL). The result is clear vision.1

Who is a Candidate for Refractive Lens Exchange?

Good candidates for refractive lens exchange include people who:

  • Have refractive errors
  • Are over age 40 
  • Are not good candidates for LASIK or other laser vision correction procedures
  • Don't want to use reading glasses or contact lenses
  • Have early cataracts

Presbyopia (or age-related farsightedness) is another common eye problem. It affects up to 80% of people by age 45 to 55.2 Refractive lens exchange is an excellent procedure for people with this condition.3

A refractive error means that the eye doesn't focus light properly because of its shape. 

These problems happen when the:

  • Eyeball is too long, causing myopia (nearsightedness)
  • Eyeball is too short, causing hyperopia (farsightedness)
  • Cornea doesn't curve correctly, causing astigmatism 

RLE Procedure: What to Expect

Refractive lens exchange is usually an outpatient procedure, meaning you can go home the same day. It is performed under local anesthesia with sedation. You are awake but relaxed during the 30-minute procedure.

Preparing for the Procedure

A week before the procedure, you'll have a comprehensive eye exam to assess vision and eye health. If you wear contact lenses, you will need to stop wearing them the week before.

During the exam, the ophthalmologist measures the shape of your eyeball and how well it focuses light. These tests help them choose the right type and power of artificial lens.

Several days before surgery, you may need to:

  • Use antibiotic eye drops to prevent infections
  • Stop taking medications such as blood thinners, ibuprofen, and aspirin 

Your doctor will provide specific instructions about preparing for the refractive lens exchange surgery.

Procedure Steps

During surgery, the surgeon will:

  1. Numb your eye with drops
  2. Make a tiny cut in the side of the cornea 
  3. Insert a probe into the eye that uses sound waves to break up and remove the natural lens
  4. Insert the IOL through the same incision (it’s folded when inserted and then unfolds inside the eye)
  5. Check that the IOL is positioned correctly and the procedure is complete

Results & Aftercare 

Arrange for someone to pick you up and stay with you after surgery. You will not be allowed to drive after the procedure. Also, plan to avoid strenuous activity for 48 hours post-surgery.

You may have blurry vision until the drops wear off. Most people have clear vision by the following day. 

You might also experience mild discomfort or a gritty sensation for a few days. You may need to use anti-inflammatory and antibiotic drops for several weeks, depending on your doctor’s instructions.

Your vision may fluctuate in the weeks following surgery as your eyes heal. Therefore, your ophthalmologist will monitor your eye health during regular eye exams.

Side Effects

No surgical procedure is without risk, including refractive lens exchange. Although side effects are usually minimal, they may include:

  • Soreness and redness. Eyes may feel tender and appear red for several weeks. Eye drops can help.
  • Vision is not as expected. There may be residual sight problems following the procedure. Therefore, you may still require glasses for some tasks. Sometimes, a second procedure is necessary.
  • Glare and halos. People may notice these visual side effects immediately after surgery. Typically, they resolve over several months.
  • Infection. If germs penetrate the eye, an infection can develop. It is treated with antibiotic eye drops.
  • Decreased night vision. This problem may be temporary or permanent.

Cost

RLE is a complex procedure that typically uses customized lenses. Cost ranges from $2,500 to $4,500 per eye, depending on the person's region, surgeon, and specific needs.

Insurance may not cover the cost because RLE is considered an elective procedure. Although, some clinics might provide financing options to make the costs more manageable.

Benefits of Refractive Lens Exchange

There are multiple benefits to RLE, including:

  • Reduces reliance on glasses or contact lenses. After RLE, most people no longer require corrective lenses. Glasses and contact lenses can cause headaches, and eye strain and require regular replacement.
  • Offers a more permanent solution than laser vision correction (LVC). The effects of LVC may not last, as eyes change naturally over time. Additionally, you can still develop a cataract and vision changes related to the natural lens. With RLE, you do not have to worry about changes in your natural lens causing your vision to shift.
  • Does not require extensive recovery time. RLE has a short recovery period. Many people resume normal activities the following day. 
  • Eliminates the potential for developing cataracts in the future. Artificial lenses do not change with age or deteriorate. Therefore, RLE provides optimal vision, and there is no risk of cataracts.
  • People who cannot have traditional LASIK may be suitable for RLE. RLE is a viable surgery for severe refractive errors, people with corneal irregularities, and other conditions. But the benefits may vary according to the underlying eye issue. 

RLE Risks & Complications

Refractive lens exchange risks include:

  • Cystoid macular edema. A painless disorder affecting the central retina. It causes cyst-like areas of fluid and swelling.
  • Posterior capsular opacity. A cloudy layer of scar tissue forms behind the lens implant.
  • Retinal detachment. The retina pulls away from its normal position at the back of the eye.

Of these, retinal detachment is the most serious. It can lead to permanent vision loss. However, it can be treated with surgery.4

Alternative Treatment Options

There are alternative treatment options for people who are not suitable candidates for RLE.

RLE vs. LASIK

LASIK is a refractive surgery that corrects vision by reshaping the cornea. It is often the preferred treatment option because it is less invasive than RLE. It also has a shorter recovery time and typically costs less. 

However, not everyone is suitable for LASIK. People with thin corneas, large pupils, or severe refractive errors are not good candidates. In these cases, RLE may be the best option.5

RLE vs. Cataract Surgery

More than 50% of Americans over 80 have had cataracts or cataract surgery.6

Cataract surgery removes the cloudy lens and replaces it with an artificial one. It is usually performed when cataracts cause vision problems. In contrast, RLE is typically performed to correct vision problems before cataracts develop.

Unlike RLE, insurance might cover cataract surgery. This is because it is medically necessary rather than an elective procedure.

RLE vs. Phakic Intraocular Lenses

Like RLE, an artificial intraocular lens is implanted in the eye. Unlike RLE, the eye’s natural lens is not removed.

They are an alternative to LASIK surgery for people who have extreme nearsightedness and cannot have laser surgery.

Summary

Refractive lens exchange (RLE) is a type of eye surgery. It corrects vision by replacing the eye's natural lens with an artificial one. 

It is performed to improve vision and eliminate the need for glasses or contact lenses.  

RLE has a short recovery time and typically provides immediate vision improvements. It is a more permanent solution than laser vision correction but may not be suitable for everyone.

7 Cited Research Articles
  1. Kaweri, L. et al. “Review of current status of refractive lens exchange and role of dysfunctional lens index as its new indication.” Indian journal of ophthalmology. 2020.
  2.   Zebardast, N. et al. “The Prevalence and Demographic Associations of Presenting Near-Vision Impairment Among Adults Living in the United States.” American journal of ophthalmology. 2017.
  3.   Alió, J. L. et al. “Refractive lens exchange in modern practice: when and when not to do it?Eye and vision. 2014.
  4.   Spielberg, L. “Long-term complications of refractive lens exchange.” Eurotimes. 2017.
  5.   Tran, K. et al. “Laser Refractive Surgery for Vision Correction: A Review of Clinical Effectiveness and Cost-effectiveness.” Canadian Agency for Drugs and Technologies in Health. 2018.
  6.   Cataract surgery.” Cleveland Clinic. 2021
  7. Stodola, E. “Comparing laser refractive surgery, phakic IOLs, and lens replacement.” Eye World. 2021.
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