Refractive lens exchange, likewise called lens replacement surgery or clear lens extraction, may be a much better choice than LASIK, PRK or phakic IOL refractive surgery for individuals with presbyopia and high hyperopia (farsightedness).
What Is Refractive Lens Exchange?
Refractive lens exchange (RLE) replaces your eye’s clear natural lens with a synthetic intraocular lens (IOL) to correct your refractive error and accomplish sharper focus, minimizing your requirement for checking out glasses or bifocals.
While lens replacement surgery technically does not have FDA approval, some eye cosmetic surgeons will perform the procedure off label in specific scenarios. This is legal and often is the most effective method to remedy specific vision problems.
Refractive lens exchange usually is for individuals with presbyopia or extreme farsightedness, for whom LASIK, PRK or phakic IOL surgery generally are not ideal. If you have both presbyopia and moderate to severe hyperopia, RLE may be the only viable choice for clear vision and very little dependence on glasses after refractive surgery.
Lens replacement surgery also can fix myopia (nearsightedness), but normally it is not recommended when LASIK, PRK or phakic IOLs are offered.
As in cataract surgery, 3 types of IOLs are offered to replace your natural lens, depending upon 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 — however not all 3 simultaneously. Toric IOLs to remedy astigmatism likewise are categorized as monofocal IOLs.
- Multifocal IOLs. A multifocal lens offers clear vision at numerous distances.
- Accommodating IOLs. An accommodating IOL is a type of monofocal lens that makes it possible for focus at numerous ranges by shifting its position in the eye.
With intraocular lenses, there is no “one size fits all,” and your eye surgeon will recommend an IOL that is most appropriate for your private requirements.
Refractive Lens Exchange: The Procedure
Lens replacement surgery usually takes about 15 minutes and is carried out on an outpatient basis. Each eye is done separately, normally about a week apart.
Numbing anesthetic drops are used during RLE, so usually there is no pain, and the majority of people report immediate vision improvement after surgery.
Preliminary recovery from refractive lens exchange — when you can resume normal daily activities — normally takes about a week.
Last outcomes of refractive lens exchange can take up to a number of weeks, and you might discover vision disturbances such as fuzzy vision, halos and glare, or a “scratchy” feeling as your eyes heal.
You must be able to go back to work and resume driving within a week of surgery, based on your eye cosmetic surgeon’s guidelines.
Generally, you will not feel an IOL in your eye, in the very same method that you do not feel a dental filling for a cavity. And considering that the lens implant is inside your eye and not on the surface like a contact lens, it’s not noticeable to others.
The artificial intraocular lens is a permanent replacement for your natural lens and is designed to last the rest of your life. Also, there is very little risk of regression (loss of restorative result or degeneration of vision) with time.
Refractive Lens Exchange For Presbyopia
Presbyopia impacts almost everyone and ends up being visible at some point after age 40 in most cases. Presbyopia is a naturally occurring age-related condition where your eye’s natural lens ends up being more firm and inflexible, and you lose the ability to concentrate on near objects.
Non-surgical options for presbyopia include reading glasses, bifocal or progressive spectacles lenses, and multifocal contact lenses. Another choice is using contact lenses for monovision.
Refractive surgery such as LASIK, PRK and phakic IOLs can not straight resolve presbyopia-induced loss of near vision.
And, although recent medical developments such as monovision LASIK and conductive keratoplasty are available, not everybody is an appropriate candidate or is within the treatment specifications of these procedures.
For people with presbyopia and moderate-to-severe hyperopia, RLE frequently is the most proper surgical alternative.
A major appeal of clear lens replacement is the recent schedule of FDA-approved multifocal IOLs (Restor by Alcon, and ReZoom and Tecnis Multifocal by Abbott Medical Optics) and accommodating IOLs (Crystalens by Baush + Lomb).
Multifocal and accommodating IOLs allow you to focus at all ranges, to get rid of presbyopia as well as bad range vision.
Refractive Lens Exchange vs. LASIK
While LASIK stays the most popular alternative for remedying myopia and hyperopia, if you have a very severe refractive error or an irregular cornea, lens-based refractive surgery such as clear lens extraction or phakic IOL implantation may be a better alternative.
Unlike LASIK or PRK, refractive lens exchange can fix practically any degree of hyperopia, and visual skill after RLE surgery typically is better than LASIK and PRK outcomes in cases of moderate and high hyperopia.
If you have myopia, RLE usually is performed only if you are not an appropriate prospect for any other vision correction surgery. People with myopia have a greater risk of retinal detachment during clear lens extraction, and other refractive surgery options should be checked out first.
Also, you need to think about thoroughly the cost of RLE. Lens replacement surgery has to do with double the cost of LASIK surgery and typically is not covered by vision insurance coverage.
Vision After Refractive Lens Exchange
Whether you will require eyeglasses or contact lenses after refractive lens exchange depends upon the type of intraocular lens used.
Monofocal IOLs have actually been used extensively in cataract surgery and clear lens exchange. They use excellent vision and contrast sensitivity and have low circumstances of vision disruptions such as halos and glare.
However, due to the fact that monofocals are designed to focus just at one distance, you will likely need glasses for up-close jobs such as reading small print and operating at a computer system (however monovision can help with your near vision).
A substantial advancement in intraocular lens surgery is the FDA approval of multifocal and accommodating IOLs, which supply vision at several distances and reduce or eliminate the need for glasses or contact lenses.
- In the FDA medical trials for the ReZoom multifocal IOL, 92 percent of people who went through the procedure said they never or just occasionally required glasses after surgery.
- The clinical results of the ReStor multifocal IOL showed that 80 percent of people in the trials did not need glasses at all after getting the implant.
- Clinical research studies of the Tecnis Multifocal IOL revealed that 88 percent of individuals in the study group did not need glasses after surgery.
- In the FDA trials for the Crystalens accommodating IOL, more than 88 percent of the study participants achieved uncorrected visual skill of 20/40 or much better at all distances after surgery.
Each IOL has advantages and disadvantages in terms of the best uncorrected vision it produces at near, intermediate and far ranges, in addition to the probability and degree of vision disruptions such as halos and night glare that might take place after surgery.
Likewise, the outcomes of one clinical trial are not directly comparable with those of another, as each study is carried out in a different method, frequently with differing endpoints and patient-enrollment criteria. Your eye surgeon will encourage on the most ideal IOL for you.
Dangers And Side Effects
Refractive lens exchange is carried out basically the very same method as cataract surgery, and for that reason RLE complications are similar to cataract surgery complications.
Refractive lens exchange typically is booked for people who are both farsighted and presbyopic (reading glasses-dependent).
Lens replacement surgery is more invasive than laser-based refractive surgery such as LASIK and PRK and includes slightly more risk.
However, sight-threatening complications are rare, and a lot of complications can be treated effectively with medication or additional surgery.
While refractive lens exchange has been proven safe and efficient, all surgery has some degree of risk, which you need to go over in information with your eye surgeon. Refractive lens exchange risks and complications consist of:
- Retinal detachment, specifically in extremely nearsighted individuals
- Dislocated IOL
- Increased eye pressure (ocular hypertension)
- Infection or bleeding inside the eye
- Saggy eyelid (ptosis)
- Glare, halos and blurred vision from multifocal IOLs
Refractive lens exchange is more invasive surgery with a greater risk of complications, compared with other vision correction procedures.
However the higher dangers might be an appropriate compromise if you have a severe refractive error and a strong desire to be less dependent on eyeglasses, contact lenses and/or reading glasses.