Refractive Lens Exchange

What is Refractive Lens Exchange?

Refractive Lens Exchange (RLE) is an alternative procedure to laser vision correction and other refractive surgical procedures. It corrects nearsightedness, farsightedness, and presbyopia using a multifocal intraocular lens implant.

Multifocal intraocular implants have recently become a popular topic in refractive surgery circles. Dr. Parent implanted one of the United States’ first multifocal lenses during the original Array lens FDA study.  Dr. Parent recently attended a conference of the American Society of Cataract & Refractive Surgery, in which the main topic was multifocal intraocular implants.  The cover feature of the February 2006 issue of EyeWorld entices readers with the prospect of “finally…no more specs”. Dr. Parent has been eliminating or drastically reducing the need for glasses for over 20 years.  

Refractive lens exchange may be the procedure of choice for patients who are too nearsighted, too farsighted or have corneas that are too thin for laser vision correction.  It is also an alternative for those over the age of 40 who wish to be less dependent on reading glasses and for those who may be showing signs of developing cataracts.

What is presbyopia?

Presbyopia is a progressive condition typically requiring individuals over the age of 40-45 years to use reading glasses or bifocals to see up close.

What is the difference between a monofocal and a multifocal lens?

A monofocal lens corrects only one distance, so you will still need to wear glasses after the surgery to see at other distances.  A multifocal lens can improve your distance, intermediate, and most of your close vision. The purpose of a multifocal lens is to be less dependent on glasses. This multifocal lens does not make vision “perfect,” but provides the patient remarkably improved vision at most distances.

How is the procedure done?

The procedure is usually done as an outpatient procedure in an ambulatory surgery center. The only difference between refractive lens exchange surgery and a cataract surgery is that cataract surgery is performed to remove a patient’s cloudy lens and refractive lens exchange is performed to reduce one’s dependence on glasses or contacts.

The eye is anesthetized to ensure the patient’s comfort during the procedure. The natural lens is removed by using ultrasonic vibrations through a micro-incision of 3mm or less in length. The natural lens is replaced by the foldable multifocal intraocular lens, which is inserted through the micro-incision. The lens spontaneously unfolds, similar to a butterfly opening its wings, as it is placed into permanent position.  No stitches are required because the small incision is self-sealing.

Does the lens move in the eye?

The lens does not move in the eye. It is held in place by locking itself into the capsule. The capsule is the liner, similar to Saran Wrap, which held the eye’s natural lens in place.

Can refractive lens exchange surgery correct astigmatism?

No, but the surgeon can make limbal relaxing incisions in the surface of the cornea to reduce the astigmatism at the same time the lensectomy is being performed. These incisions can reduce or eliminate the astigmatism. There are also intraocular astigmatic lenses, but they are not produced in the multifocal platform at this time.

Can both eyes be done at the same time?

No, the eyes cannot be done at the same time because it is an invasive surgery. Dr. Parent wants to make certain the operative eye is healing correctly before proceeding with the second eye. The first eye to be done is usually the patient’s non-dominant eye.

Are you asleep during the surgery?

No, the patients are very sleepy but remain somewhat awake so that they can cooperate during the procedure. They are given medication to help keep them relaxed and the eye is anesthetized to ensure the patient’s comfort.

How long does the procedure last?

The procedure can last between seven to sixty minutes, varying with each individual.

What is the healing time after refractive lens exchange?

The patient is allowed to perform his or her routine, daily tasks immediately after the procedure, but it could take up to three months for them to adjust to their new vision. Their vision can continue to improve for up to 1 year and beyond.

Will the intraocular lens implant need to be replaced?

The intraocular implant will not need to be replaced.

Does insurance pay for refractive lens exchange?

No. Refractive lens exchange is considered an elective surgery. If you have cataracts, then your insurance may pay for the surgery, but you will be responsible for the cost of the upgraded multifocal lens.