Though LASIK is the most popular vision correction surgery in the United States, some people are not good candidates for laser vision correction.
Also, many refractive surgeons prefer not to perform LASIK on older patients who have or may soon have cataracts that would make the benefits of LASIK short-lived.
For these patients, many eye surgeons are turning to an elective vision correction procedure called refractive lens exchange, or RLE. In this procedure, the lens inside the eye is removed and replaced with a man-made intraocular lens (IOL) — like in cataract surgery.
In the March 2010 issue of EyeWorld, two experienced refractive surgeons discussed the advantages of RLE and the techniques they prefer when performing the procedure.
Stanley Berke, MD, associate clinical professor of ophthalmology and visual sciences at Albert Einstein College of Medicine (New York, N.Y.) says RLE is a good choice for patients who desire vision correction surgery but are poor candidates for LASIK because their corneas are too thin, they have too much nearsightedness or farsightedness or because of other risk factors.
Jason Stahl, MD, assistant clinical professor of ophthalmology at Kansas University Medical Center (Kansas City, Kan.) says that normal age-related lens changes in the eyes of people in their late 40s and 50s can cause light scatter that degrades vision, even before a cataract forms in the lens.
Replacing the aging lens with an IOL via the refractive lens exchange procedure can improve vision in these patients, he says.
Dr. Stahl says RLE offers older patients who desire vision correction surgery a number of advantages:
- When using an accommodating IOL or a multifocal IOL, RLE can restore both distance and near vision in a person who has presbyopia.
- RLE can eliminate the need for cataract surgery in the future.
- RLE stabilizes the optics of the eye, reducing the risk of changes in a person’s eyeglass prescription and visual acuity because of increasing refractive errors.
Both surgeons emphasized that patient education about the RLE procedure, including risks and potential outcomes, are essential so patients have realistic expectations about what the surgery can and cannot do for them.
They also said a thorough pre-operative exam is necessary to rule out eye problems other than normal age-related lens changes that could affect visual outcomes, and post-operative care is needed to avoid unwanted complications.
In some cases, a follow-up refractive procedure such as LASIK or PRK may be needed to fine-tune the refractive result for optimal uncorrected visual acuity.
SOURCE: Â Considering refractive lens exchange. EyeWorld. March 2010.
Tags: IOLs, Multifocal IOLs