People who have errors of refraction often need to wear eyeglasses or contact lenses to improve their vision. Errors of refraction include nearsightedness (myopia), farsightedness (hyperopia), astigmatism (distortion of vision) and presbyopia (blurred vision when reading, associated with aging). However, using eyeglasses or contact lenses daily can be very inconvenient to some people, especially when these interfere with their jobs, hobbies, or lifestyle. Refractive lens exchange (RLE) is one of various surgical options offered by eye surgeons for people who have presbyopia and extreme hyperopia. It is considered by some to be a better option compared to laser eye surgery or implantable lenses.

What Is It?

This is a type of eye surgery that involves replacement of the natural lens of the eye with an artificial lens or more commonly known as IOL (intraocular lens). The aim is to correct the refractive error of the eye to achieve sharp focus and eliminate the need for using corrective eyeglasses or contact lenses.

As its name suggests, RLE involves the extraction of the clear natural lens (as opposed to extraction of cataracts), which is exchanged with artificial lens that can improve your vision. This procedure is very similar to that of cataract surgery, where the cloudy lens (cataract) associated with normal aging is removed and replaced with an IOL. Although it is not technically approved by the FDA, eye surgeons can perform the surgery legally because it is considered an effective way of correcting certain vision problems.

Refractive Lens Exchange Procedure

This type of refractive surgery is an outpatient procedure that can be done in fifteen minutes. There is no need to stay overnight in the hospital and improvement in vision is immediate. However, the surgery is performed on each eye a week apart.

To numb the eye and prevent pain and discomfort during the surgery, anesthetic drops are applied on the eye. The natural lens is first extracted and then replaced by an intraocular lens or IOL, which may be one of three types:

• Monofocal IOL, which improves near, intermediate, or distance vision, though not all at once. A special type of monofocal IOL is the toric IOL, which helps correct astigmatism
• Multifocal IOL, which improves vision at various distances; ex. ReZoom, Tecnis Multifocal (Abbott Medical Optics) and Restor (Alcon)
• Accommodating IOL, which, by shifting positions within the eye, enables you to focus at various distances; ex. Crystalens (Baush + Lomb)

Your eye doctor will recommend a suitable type of IOL for your specific needs. You can expect to be able to resume your normal activities in about a week.

Benefits of Refractive Lens Exchange

This lens replacement surgery is a safe and effective way of correcting various refractive problems:

1. Presbyopia. People normally start to lose their visual acuity for reading or near vision after they turn 40 years of age. This condition, called presbyopia, causes your natural lens to become firm and less flexible so that you are not able to focus on printed reading material or near objects.
2. Hyperopia and extreme farsightedness. Having extreme hyperopia and presbyopia may be difficult to correct and RLE is a good option. RLE can correct various degrees of hyperopia, and many believe that results are often better than outcomes from laser surgery (LASIK) and implantable lenses (photorefractive keratectomy or PRK) for moderate and extreme hyperopia.
3. Myopia. Nearsightedness is an indication for RLE if other options like Lasik or PRK are not suitable for you.
4. Cataracts. The natural lens begins to become cloudy during middle age and this condition gradually progresses until old age, when vision may be completely obscured. Some eye doctors wait for the cataracts to mature before extracting them and implanting IOLs, but now you could opt to have your lens replaced before the cataracts progress to that point when they have significantly reduced your vision.

What to Expect After Refractive Lens Exchange

Although you may be able to resume everyday activities such as driving, within a week after surgery, the outcome of your vision can take several weeks. You may experience vision disturbances such as blurring, glares, and halos, as well as a scratchy feeling in the eyes. However, you cannot see or feel the presence of the IOL in the eye.

IOLs do not change with age and unlike your natural lens, they do not lead to deterioration of your vision even as you grow older.

Although RLE may be a good alternative to using eyeglasses or contact lenses as well as other refractive surgical procedures, one must consider some of its risks and disadvantages.

Risks of RLE

For people who are nearsighted or myopic, RLE is not the first treatment option and it should only be considered if other corrective procedures are not suitable to a person's needs. This is because myopia carries with it a higher risk of complications such as retinal detachment during surgery.

Depending on the type of IOL used, you may need to use contacts or eyeglasses after RLE. Monofocal IOLs are designed for focusing only at a single distance, so you will most likely need eyeglasses to read fine print or work at the computer.

Compared to laser eye surgery or implantable lens, RLE is more invasive and therefore carries more risks, such as:

• Retinal detachment
• Dislocation of the IOL
• Increase in eye pressure
• Eye infection
• Bleeding
• Droopy eyelids
• Blurry vision, glare and halos

Another disadvantage of RLE is the cost, since the price can be double than that of laser surgery (Lasik). Your expenses may not be covered by insurance.

If you are considering having reflective lens exchange to correct your vision problems, consult your eye doctor for advice and consider its advantages and disadvantages.