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Refractive Lens Exchange (RLE) – An Alternative to LASIK

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    Jay Lustbader, MD
    W. Neil Wills, MD, FACS

    LasikPlus Vision Center
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    McLean, VA 22102
    (866) 724-6033
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    TLC Laser Eye Centers

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  • Lustbader 50x50 Wills 50x50

    Jay Lustbader, MD
    W. Neil Wills, MD, FACS

    LasikPlus Vision Center
    800 King Farm Blvd.
    Suite 135
    Rockville, MD 20850
    (866) 724-6033
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Refractive lens exchange (RLE) is a type of vision correction surgery in which the eye's natural lens is removed and replaced with a man-made intraocular lens (IOL). Alternative names occasionally used for RLE are clear lens exchange, clear lens extraction or CLE. This is not a type of corneal implant or inlay.

Refractive lens exchange is essentially the same surgical procedure as cataract surgery, which is performed on approximately three million Americans each year. But in RLE, the eye's natural lens is not clouded—the clear lens is removed and replaced with an IOL simply to change the focusing power of the eye. Refractive lens exchange can reduce or eliminate large amounts of nearsightedness and farsightedness and therefore may be a better surgical solution than LASIK for high prescriptions.

Because refractive lens exchange is an internal eye procedure with the potential for more risks and complications than laser vision correction surgery, RLE is generally reserved for people who are not good candidates for LASIK, PRK or other laser procedures or who have high amounts of nearsightedness or farsightedness that are beyond the accepted treatment range for laser surgery.

RLE can correct a wide range of refractive error, from +8.00 diopters (D) of farsightedness to -20.0 D of nearsightedness. It can also correct up to 3.50 D of astigmatism if an astigmatism-correcting toric IOL is used.

The same refractive intraocular lenses used for cataract surgery can be used for RLE, including accommodating IOLs and multifocal IOLs to correct presbyopia as well as refractive errors. (When refractive lens exchange is performed using a multifocal IOL and using a laser to remove the natural lens, outcomes for the treatment of presbyopia are improved. This is a different type of laser presbyopia treatment than multifocal LASIK or presbyopia LASIK.)

Advantages of RLE

RLE can effectively correct high amounts of nearsightedness and farsightedness that may not be adequately corrected by LASIK. It also is a viable alternative to LASIK for eyes with corneas that may be too thin for laser vision correction.

Other advantages of RLE include:

  • Rapid visual recovery
  • The normal shape and thickness of the cornea remains unchanged
  • The need for cataract surgery in the future is eliminated
  • It provides stable vision with no risk of regression (loss of corrective effect)
  • With multifocal IOLs, can correct presbyopia and reduce the need for reading glasses
  • It enables people with mild cataracts to have refractive surgery.

RLE Risks and Complications

The risks and potential complications of refractive lens exchange are virtually the same as those for cataract surgery. If you are considering RLE, you must be willing to accept these risks, which can occur even when RLE is performed flawlessly by a skilled and experienced refractive surgeon or cataract surgeon.

RLE risks and potential complications include:

  • Retinal detachment
  • Glaucoma
  • Posterior capsular occlusion (PCO, or "secondary cataract")
  • Infection
  • Dislocation of the IOL
  • Overcorrection or undercorrection
  • Bleeding inside the eye

RLE Candidates

Candidates for RLE should meet these criteria:

  • At least 21 years of age
  • Stable vision (no change in eyeglasses prescription for at least six months)
  • Healthy eyes with no history of eye disease
  • Be willing to accept the risks associated with RLE

Many refractive surgeons feel the best candidates for RLE are people with moderate to high hyperopia (farsightedness) and people with hyperopia who also are over age 45 and have presbyopia.

Patients with hyperopia appear to have a lower risk of retinal detachment after RLE than highly nearsighted individuals,1 and use of a multifocal IOL can correct presbyopia and reduce the need for reading glasses.

Refractive Lens Exchange Cost

Refractive lens exchange costs significantly more than LASIK, PRK or other laser vision correction procedures, and vision insurance typically does not cover any of the cost.

Expect total surgical fees for RLE to be approximately twice that of LASIK, or approximately $4,000 per eye.

You can lower your surgical costs for refractive lens exchange by setting up a Health Savings Account (HSA) at your bank or contributing to flexible health benefits program at work. Many refractive surgeons also offer financing programs that allow you to pay for the procedure over time at attractive interest rates or interest-free over a limited time frame.

Finding a RLE Surgeon

Many cataract surgeons and laser refractive surgeons also offer refractive lens exchange. When considering your refractive surgery options, ask your eye doctor if RLE is a viable choice for your vision correction needs.

1Complication risks must be discussed with RLE patients. Ophthalmology Times, March 15, 2008.

Note: This information is for general education purposes only. It is not to be used as a substitute for medical advice from your eye doctor or refractive surgeon.

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