What is Refractive Lens Exchange Surgery?

Refractive Lens Exchange is a type of vision correction surgery that involves using ultrasound to remove the natural lens of the eye and replacing it with an intraocular lens (IOL) to minimize the use of glasses and contacts.

Who is a Good Candidate for Refractive Lens Exchange (RLE)?

Refractive Lens Exchange is an excellent procedure for people who are over age 40-50 and are nearsighted (distant objects appear blurry) or farsighted (close objects appear blurry), people with early cataract formation, and individuals who want to treat presbyopia (gradual decline in the ability to focus on close objects) with a multifocal implant. For some patients, RLE can be a great alternative to LASIK.

Refractive Lens Exchange is for those who:

  • Any patient who is over age 40-5o who is nearsighted, farsighted, or has astigmatism
  • Want to reduce or eliminate their dependence on glasses or contact lenses
  • Have early clouding of the lens (dysfunctional lens syndrome)-which is uniform after age 50
  • Anyone who is nearsighted,  farsighted or has astigmatism who has early cataracts (clouding of the lens)
  • Want to treat presbyopia with a multifocal implant
  • Are looking for an alternative to LASIK

What to Expect on Surgery Day

Refractive Lens Exchange is performed in our in-office surgery suite, and only takes about 7 to 10 minutes per eye! Both eyes are typically done on the same day.

Upon arrival for your surgery, you will be given a mild sedative (usually Ativan) and you will be given an anesthetic eye drop to numb your eye during the procedure. The skin around your eye will be thoroughly cleansed, and sterile coverings will be placed around your eye to keep the surgical area clean during the procedure. Your eye will be held open with an eyelid holder so you will not have to worry about blinking during the procedure.

Under an operating microscope, your doctor will create a tiny opening to the eye. The natural lens is gently fragmented and removed by the use of ultrasound (sometimes with the assistance of a femtosecond laser). Then a plastic intraocular lens (IOL) is implanted to replace the natural lens that was removed. Your doctor will determine which type of IOL is best for you (see below for IOL options). The small opening in the eye closes without stitches.  Vision typically begins to clear within a few days.

Intraocular Lenses (IOLs) Available at Dougherty Laser Vision

Premium IOL Packages

At the time of cataract surgery, an intra-ocular lens (IOL) must be placed into the eye to replace your natural lens in order for you to see.  Traditionally, a basic IOL was placed at the time of surgery with the expectation that glasses or contacts would be needed to maximize vision after surgery. At DLV Vision, we offer a range of IOL’s as part of a Premium IOL package that can help improve vision and decrease or eliminate the need for glasses or contact lenses at the time of surgery.  Unlike many surgeons, at DLV Vision, we see each cataract surgery as a unique opportunity to correct your vision to minimize use of glasses.  Each Premium IOL Package offered at our center includes astigmatism correction as well as Laser Vision Correction (LASIK or PRK) at no charge after surgery, if necessary, to maximize your vision without glasses.

Softec HD IOL

Softec HD Lens was developed to meet higher patient expectations for higher quality vision. The Softec HD is manufactured as a bi-aspheric IOL, which improves quality of vision compared to traditional IOL’s.  In addition, this lens is one of the most precisely manufactured IOL’s in the world.  As a result, the Softec HD comes 0.25 D increments which allows for a more precise vision correction outcome; most IOLs on the market are only available in less accurate 0.5 D steps.  Lastly and most importantly, the Softec HD is made of hydrophilic acrylic material, which studies have shown allows for an increased depth of focus and better intermediate vision without glasses.  While the Softec HD will not eliminate reading glasses unless monovision (1 eye set for distance, and 1 eye set for near) is employed, many patients get good intermediate vision in addition to excellent distance vision without glasses.

Find out more about the Softec HD Lens, watch the video below.

Monovision IOL

Monovision lenses correct a patient’s dominant eye for distance and leave the non-dominate eye slightly undercorrected so the patient can retain the ability to see near. Many people who have tried monovision in contact lenses have had similar success with monovision IOLs.

Toric Astigmatism Correcting IOLs

View Video
The cornea (clear window in front of the eye) on a normal eye has a circular shape whereas in an eye with astigmatism, the cornea is shaped more like an oval.  This oval shape creates 2 points of focus in the eye.  Astigmatism is a common eye condition that affects millions of people and often leads to blurred or impaired vision at both distance and near. With advancements in lens technology, it is now possible to correct astigmatism with Toric lenses that correct astigmatism. The FDA-Approved premium Toric lens is a single lens that is implanted during cataract surgery to replace the clouded lens.

Multifocal IOLs

If you’re looking to release yourself from the dependency of glasses after surgery and you can not tolerate monovision (1 eye set for distance and 1 eye set for near), you should ask about the options for multifocal lenses to expand your range of vision. Tecnis Multifocal (MF) lenses allow a patient to have the advanced vision at distance and near regardless of your pupil size. Multifocal IOL’s work by using diffraction rings on the lens that optically split the incoming light into distance and near so that you can see both distance and near by the brain paying attention to the appropriate image.

Tecnis MF IOL’s all allow for distance vision and are available in 3 powers for close vision – +2.75 for arms length, +3.25 for book distance, and +4.00 for very near tasks.  The main downside of MF IOL’s is that you will notice halos (rings around lights) or halo (blurring around a point light source) at night or in low lights due to the rings on the optic (see animation below).  The night vision symptoms tend to be mild and improve with time in most patients, but can sometimes affect an individual’s ability to drive at night or to perform other visual tasks. The other downside of MF IOLs is that there is only a single near point that is clearly in focus rather than a full range of vision.

Halo Glare Image

Symfony Lenses

Tecnis Symfony® Intraocular Lens is a type of multi-focal lens called an Extended Depth of Focus (EDOF) IOL that can give a continuous range of vision from distance to intermediate (computer vision).  The FDA approval includes a version of the lens for people with astigmatism, the Tecnis Symfony Toric IOL.

The Symfony typically provides high-quality vision. Some IOLs may leave patients with an inability to focus clearly due to competing wavelengths of light passing through the lens at different angles (known as chromatic aberration), or with vision that is not completely focused because of the shape of the lens (known as spherical aberration). The Symfony lens has been engineered to correct these issues.

The main downside of Symfony IOL’s is that while good distance and intermediate vision may be achieved, most patients require glasses for reading, particularly for fine or low-contrast print.  The other downside of Symfony is the tendency for glare, halo, and/or starburst (rays of light coming seen to be coming off of a point light source) in low light or nighttime that can sometimes affect an individual’s ability to drive at night or to perform other visual tasks.

What Are the Risks Associated with Refractive Lens Exchange?

Any surgical procedure comes with inherent risk. Although very uncommon, risks associated with RLE are similar to that of cataract surgery including bleeding, swelling, infection, retinal detachment, and capsular opacification. During your pre-operative consultation, your doctor will answer any questions and thoroughly explain these and any other risks associated with RLE.

Refractive Lens Exchange Surgery at Dougherty Laser Vision

Refractive Lens Exchange surgery is a refractive surgery option for patients over 40-50 years of age with presbyopia, farsightedness, or nearsightedness.  The only way to determine if RLE is a better option than LASIK, PRK or a different surgery is to schedule a complimentary consultation at Dougherty Laser Vision. Call or contact us online to answer any questions and schedule your complimentary consultation at one of our locations today.