Refractive Lens exchange
Refractive Lens Exchange (RLE) is essentially cataract surgery, but exclusively for refractive purposes. RLE is sometimes called Clear Lens Exchange (CLE), Clear Lens Extraction (CLE), and Refractive Lens Replacement (RLR). RLE is often an appropriate alternative to conventional or wavefront Lasik, All-Laser Lasik, PRK, LASEK, Epi-Lasik if the patient is presbyopic or if LASIK is not suitable because of thin corneas or dry eye symtoms.
Exchange The Natural Lens
In RLE the natural lens of the eye is removed and replaced with a plastic intraocular lens (IOL). The replacement IOL is of a power to correct most, if not all, of the patient's hyperopia or myopia or astigmatism.
Advantages of RLE
There are several advantages to RLE over other forms of refractive surgery. Some of the most obvious are that the surgery has years of successful history and the cornea is relatively untouched. If you have a thin cornea, dry eyes, or other minor cornea problems, RLE may be a better alternative. RLE may be the only option for people with high refractive error. Also, if the exact desired refractive change is not achieved, the IOL may be exchanged for one of a different power, or a cornea-based refractive surgery technique such as conventional or custom wavefront Lasik, All-Laser Lasik, PRK, LASEK, CK, or Epi-Lasik may be used in combination with RLE to "fine tune" the correction. Because RLE removes the natural lens, there is no possibiliy of developing a cataract in the future.
Disadvantages of RLE
RLE is a significantly more invasive surgery than any cornea-based refractive surgery. However, cataract surgery has a long and well established track record, and as the procedure for RLE is the same as cataract surgery - the risks inherent to the procedure are the same. Additional issues are that glasses are needed for some tasks and for a minority may be needed for all tasks after the procedure, or further surgery may be required to fine tune the result. An extremely myopic patient would have an elevated risk of vitreous or retina problems after RLE, as is the case for any intraocular surgery in this setting.
If you have accommodation, you may loose some or all accommodation. If you are already fully presbyopic and need powerful reading glasses or bifocals, the reduction of accommodation with RLE may not be a problem because you already have a very limited range of accommodation.
See Distant and Near
Most IOLs cannot accommodate by changing focus from distance to near like a young and healthy natural lens. Your eye will be set to either near vision or far vision. New accommodating IOL designs such as the Tetraflex and Crystalens do have the ability to provide some accommodation. You may also have multifocal IOLs such as the ReSTOR and the ReZoom implanted that help with near and distance vision. You should discuss with your surgeon if a multifocal or accommodating IOL is appropriate for your circumstances. It is possible to be corrected for monovision with RLE. Monovision is another method to receive some advantage of near and distant vision and resolve presbyopia.
If you already have cataracts starting to form, RLE may make a lot of sense. If you are already presbyopic, RLE may be a better alternative than corneal laser refractive surgery. There is hardly any point in having laser surgery to the cornea if within a short period of time you will be having cataract surgery anyway or you already cannot change focus from distance to near.
A Cataract Surgeon, Perhaps Not a Lasik Surgeon
Something important to note is that RLE is often not performed by refractive clinics or surgeons who specialize only in cornea based conventional or custom wavefront Lasik, All-Laser Lasik, LASEK, PRK, Epi-Lasik, and CK. RLE is very different from these procedures. For this reason, a Lasik clinic may not even mention RLE, let alone provide it. For successful RLE, you should select a doctor who has both extensive cataract experience and extensive experience with RLE.
A range of implants is available to suit desired goals. Further information about this is on the Choice of Implants page.