Refractive Lens Exchange: Latest Trend For 40+ Seeking To Get Rid Of Glasses & Contacts

Refractive lens exchange, also called lens replacement surgery or clear lens extraction, may be a better option than LASIK, PRK or phakic IOL refractive surgery for people with presbyopia and hyperopia (farsightedness).  Refractive lens exchange (RLE) replaces your eye's clear natural lens with a multifocal intraocular lens (TECNIS IOL) to correct your refractive error and achieve sharper focus, reducing your need for reading glasses or bifocals.  Refractive lens exchange typically is for people with presbyopia or extreme farsightedness, for whom LASIK, PRK or phakic IOL surgery generally are not suitable. If you have both presbyopia and moderate to severe hyperopia, RLE may be the only viable option for clear vision and minimal reliance on glasses after refractive surgery.  Lens replacement surgery also can correct myopia (nearsightedness), but generally it is not recommended when LASIK, PRK or phakic IOLs are available.  The procedure for refractive lens exchange is virtually identical to cataract surgery. The difference is that in RLE, the lens being replaced is clear, rather than a cloudy lens due to a cataract.

Refractive Lens Exchange: The Procedure

Lens replacement surgery usually takes about 15 minutes and is performed on an outpatient basis. Each eye is done separately, usually about 2 weeks apart.  Numbing anesthetic drops are used during RLE, so typically there is no discomfort, and most people report immediate vision improvement after surgery.  Initial recovery from refractive lens exchange — when you can resume normal everyday activities — usually takes about a week.  Final outcomes of refractive lens exchange can take up to several weeks, and you may notice vision disturbances such as blurry vision, halos and glare, or a "scratchy" sensation as your eyes heal.  You should be able to return to work and resume driving within a week of surgery, dependent on your eye surgeon's instructions.  Normally, you won't feel an IOL in your eye, in the same way that you don't feel a dental filling for a cavity.  Also, since the lens is situated inside your eye and not on the surface like a contact lens, it is not visible to the naked eye.  The artificial intraocular lens is a permanent replacement for your natural lens and is designed to last the rest of your life.  And, because IOLs are not affected by age-related changes, there is minimal risk of regression (loss of corrective effect or deterioration of vision) over time.

Refractive Lens Exchange for Presbyopia

Presbyopia affects just about everyone and becomes noticeable sometime after age 40 in most cases. Presbyopia is a naturally occurring age-related condition where your eye's natural lens becomes more firm and inflexible, and you lose accommodation (the ability to focus on near objects). 

Non-surgical options for presbyopia include reading glasses, bifocal or progressive eyeglass lenses, and multifocal contactlenses. Another option is wearing contact lenses for monovision.  Refractive surgery such as LASIK, PRK and phakic IOLs cannot directly address presbyopia-induced loss of near vision.  And, although recent medical advancements such as monovision LASIK and conductive keratoplasty are available, not everyone is a suitable candidate or is within the treatment parameters of these procedures.  For people with presbyopia and moderate-to-severe hyperopia, RLE often is the most appropriate surgical option.  Multifocal and accommodating IOLs enable you to focus at all distances, to overcome presbyopia as well as poor distance vision.

RLE: A Treatment for Early Cataracts?

People who are middle-aged or older may have the beginnings of cataracts that eventually could worsen and require cataract surgery.  If you have early cataracts, you could choose to have lens replacement surgery instead of waiting for the cataracts to progress to the point where they cause vision loss and have to be removed.  Intraocular lenses can provide significantly better uncorrected vision at that point, especially if you are reliant on eyeglasses or contact lenses.  An added benefit of clear lens extraction is that it eliminates the risk of cataracts, because the eye's natural lens is replaced with an artificial lens implant.  Non-surgical options for presbyopia include reading glasses, bifocal or progressive eyeglass lenses, and multifocal contact lenses. Another option is wearing contact lenses for monovision.  Refractive surgery such as LASIK, PRK and phakic IOLs cannot directly address presbyopia-induced loss of near vision.  And, although recent medical advancements such as monovision LASIK and conductive keratoplasty are available, not everyone is a suitable candidate or is within the treatment parameters of these procedures. 

For people with presbyopia and moderate-to-severe hyperopia, RLE often is the most appropriate surgical option.  Multifocal and accommodating IOLs enable you to focus at all distances, to overcome presbyopia as well as poor distance vision.  You should discuss these options with your Ophthalmologist. 

WHO is an ideal candidate for the Refractive Lens Exchange Procedure?

·         Someone who is in good health and has healthy eyes, Dr. Bogart will determine
       this at your exam

·         Someone who is tired of wearing glasses or contact lenses

·         Someone who is not capable of doing monovison

·         Someone who is Farsighted (Hyperopic), or Presbyopic, or Nearsighted (Myopic),
       or Astigmatic

·         Someone who wants to be less-dependent on glasses/contacts

·         Someone who doesn’t want to feel ‘old’- reading glasses can make some people
       feel older

·         Someone who is very active, athletic, interested in travel, or other outdoor
       activities

 

The ideal candidate for a RLE is someone:

·         Keenly interested in spectacle independence for most distance and near tasks

·         With an easy-going personality and a positive demeanor

·         Willing to accept a small compromise in distance acuity

·         Willing to understand that it is not a procedure with a guaranteed outcome

·         Generally more interested in working with you in something of a partnership

·         Whose near tasks include mostly reading

·         With moderate to high hyperopia without heavy dependence on computer work
       or moderate to high myopia, although the latter will tend to be relatively
       less satisfied.

 

The RLE procedure is NOT suited for someone:

·         Who does not mind wearing glasses

·         Hypercritical with unrealistic expectations and will never be satisfied

·         Where sharpest clearest vision is their main concern

·         With a heavy dependence on intermediate vision, night vision, or specific job
       requirements; eg, pilots, public service vehicle, taxi, or truck drivers

·         Low myopes (nearsightedness) in general as they are used to excellent
       uncorrected reading vision that will be difficult to match or surpass


If you would like to schedule an appointment to find out if an RLE is the right option for you, give our office a call today:  803-794-0000, Ext. 4, ask for Jennifer!