Consultant Ophthalmologist,
Cataract & Refractive Surgeon

BMedSci BM BS MRCS MRCSEd MRCOpth FRCOphth MMedLaw PgD Cataract & Refractive Surgery

Refractive Lens Exchange

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Everyone gets cataract (clouding of the lens) as they get less young. Whether the cataract requires surgical intervention depends upon the effect on your vision and quality of life.

If you of an age where you already need reading spectacles then removing your lens (effectively doing cataract surgery on you) even though there is no or minimal cataract is an option. I can put a lens into the eye that would correct your long or short sightedness and also I have the option of putting a toric lens into the eye to correct any astigmatism.

Refractive lens exchange (RLE), also called lens replacement surgery or clear lens extraction, may be a better option than a phakic IOL or laser refractive surgery.

This is a particularly good option for people who are very long sighted.

One of the problems is that the new lens does not change shape whereas your native lens changes shape to allow you to see in the distance and close up. As we get older the elasticity in the lens disappears and we become reliant upon reading spectacles to read close up. If you are already at that stage then RLE may be a good option for you.

The procedure for RLE is effectively 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.

As in cataract surgery there are different types of IOLs that are available to replace your natural lens, depending on your vision needs and the health of your eyes.

They are:

  • Monofocal fixed-focus IOLs. Monofocal lenses provide clear vision at distance, intermediate or near ranges — but not all three at once.
  • Toric IOLs to correct astigmatism.
  • Multifocal IOLs. A multifocal lens provides clear vision at multiple distances.

Risks and Side Effects

Refractive lens exchange is performed essentially the same way as cataract surgery, and therefore RLE complications are similar to cataract surgery complications.

However, sight-threatening complications are rare, and most complications can be treated successfully with medication or additional surgery.

While refractive lens exchange has been proven safe and effective, all surgery has some degree of risk, which you should discuss in detail with your eye surgeon. Refractive lens exchange risks and complications include:

  • Retinal detachment, especially in extremely nearsighted people.
  • Dislocated IOL
  • Increased eye pressure (ocular hypertension)
  • Infection or bleeding inside the eye
  • Glare, halos and blurry vision from multifocal IOLs
  • Refractive lens exchange is more invasive surgery with a higher risk of complications, compared with other vision correction procedures.

But the higher risks may be an acceptable trade-off if you have a severe refractive error and a strong desire to be less dependent on eyeglasses, contact lenses and/or reading glasses.