Refractive Lens Exchange in Northern California

What is refractive lens exchange (RLE)?

RLE is a surgical procedure in which the natural lens of the eye is removed and replaced with an artificial lens. RLE, sometimes called "clear lens extraction," is most commonly performed on patients older than 40 who have high levels of hyperopia (better distance vision than near vision). RLE is also commonly performed on patients who are not good candidates for laser vision correction because of thin or flat corneas or high levels of hyperopia.

Because RLE eliminates the ability of the natural lens to adjust for reading and other activities that involve near vision, it may not be a good option for patients under 40, unless an accommodative or pseudo-accommodative IOL is used. (After about age 40, most people's eyes begin to naturally lose their ability to focus at different distances.) A pseudo-accommodative lens may help with near vision or intermediate distance vision.

What are the potential benefits of RLE?

Prevention of future cataract development.
Good-to-excellent far vision following monofocal lens implantation (some tasks may still require eyeglasses).
Good-to-excellent near, intermediate, and far vision with an accommodative or pseudo-accommodative lens.
Possible reduced likelihood of future need for laser vision correction or eyeglasses.

What are the risks of RLE?

RLE is essentially a variation of cataract surgery. Cataract surgery is one of the most common surgeries in the United States. However, risks for these procedures include:

A period of anisometropia, an imbalance between the eyes. This occurs because the operation on each eye is performed separately. The condition will resolve after the operation to the second eye.
Potential mild discomfort for the first 24 hours after the procedure (severe pain is rare).
Endophthalmitis, an intraocular infection that can lead to blindness. This occurs in 0.01 percent of cases after standard cataract or RLE procedures. If caught early and treated aggressively with antibiotics, the risk of vision loss can be reduced, but patients can lose their vision permanently.
Posterior capsular opacification, a clouding of the eye's natural lens capsule. This occurs in about 25 percent of cataract surgery patients but can be easily treated with a brief office laser procedure after the surgery. Some lens designs may inhibit or delay opacification.
Retinal detachment.
Cystoid macular edema, a swelling of the central area of the retina. This often can be improved with treatment, but some patients may experience permanent residual visual disturbances.
Corneal edema, clouding and swelling of the front "window" of the eye. This condition is correctable with eyedrops, and may spontaneously heal naturally. In rare cases, a corneal transplant may be required.
Iritis, an inflammation of the eye from mechanical irritation.
Damage to the retina or optic nerve during administration of the anesthesia.
Increased astigmatism.
Glaucoma.
With an accommodative or pseudo-accommodative IOL, less sharp vision, glare, or halos around lights, becoming worse in dim light, in fog, or at night.

What should I expect on the day of surgery?

RLE is similar to cataract surgery. A very small incision, just two to three millimeters long, is made at the edge of the clear cornea, which is the transparent covering of the front of the eye.

A probe is inserted through the tiny incision and used to gently fragment the lens with high-frequency sound waves and remove the fragmented pieces. Once the lens has been removed, a tiny new clear implant lens is inserted in its place. RLE is typically performed on one eye first and then the second eye one to four weeks later, after the first eye has stabilized.

RLE is typically performed under local anesthesia in an ambulatory surgery center, but the type of anesthesia can be varied to best suit your needs. The procedure takes 15 to 30 minutes and your visit, including preoperative and postoperative care, will last one to two hours. You'll need someone to drive you home after your surgery.

What should I expect during recovery and postoperative care?

The day after your surgery, you'll come in for an office visit with your laser vision correction surgeon to help ensure that you're healing properly. Some patients have blurred vision the day after surgery, while some already see clearly - every patient heals differently.