What is a Refractive Lens Exchange?
We are born with a flexible lens inside the eye that is able to focus light on the retina and give us vision. As we grow, the eye and the lens change thus forcing most people to wear glasses for the best vision. As we get older, the lens loses flexibility, and we lose the ability to focus on near objects which require the use of reading or bifocal glasses. Many people find the process very frustrating and may elect to remove the natural lens and replace it with a plastic Multifocal Lens. The surgery is equivalent to performing cataract surgery without waiting for the cataract to form and is therefore considered Cosmetic from the insurance standpoint.
An Alternative to LASIK
For patients desiring to reduce their dependence on contacts and glasses, multiple options now exist. Historically, LASIK was the best option, however, after a certain age, when the loss of reading vision occurs (presbyopia), there are better options. For some patients, Refractive Lens Exchange (RLE) has become a preferred alternative to Lasik to reduce dependence on glasses and contacts.
Advantages of RLE over LASIK
- Lifelong results. LASIK does not prevent cataract development. So most patients will have to undergo a second surgical procedure (cataract surgery) after their LASIK.
- Advanced technology lens implants can provide both reading and distance vision out of each eye. LASIK can only offer reading vision through monovision (one eye set for distance and one eye made nearsighted). Monovision does decrease depth perception and cannot be tolerated by everyone. Monovision also fades with the aging process. RLE can restore a full range of vision in both eyes with lifelong results.
What is the goal of the surgery?
The goal of refractive lens exchange is to restore distance and near vision with greatly reduced dependence on glasses. It cannot fix problems and restore vision loss due to glaucoma, macular degeneration, or irregular astigmatism.
How is the procedure performed?
The surgery is performed on an outpatient basis with local anesthesia. The entire eye is anesthetized to keep the patient from feeling any pain, and there is no longer a need in putting patients to sleep. The procedure is typically performed in 10-15 minutes where the old lens is removed and replaced with a clear plastic implant. In most cases, the vision is quite good within the first 24 hours and continues to improve over the first month. For most cases, a combination of steroids and antibiotics is injected at the end of the case to greatly reduce the number of drops needed after surgery – “Dropless Cataract Surgery.”
The most modern advancements in technology are used to greatly enhance the success rate and outcomes. The Femtosecond Laser is used to make the incisions in the cornea with great precision to help correct astigmatism. The laser also makes incisions in the cataract to cut it into many pieces to allow for much more gentle removal of the lens particles and necessitates much less energy use inside the eye to allow for faster recovery and less damage to the surrounding tissue.
The ORA/Verion system allows measuring the eye one last time after the cataract was removed during the procedure before the implant is inserted. This allows for much higher accuracy in choosing the strength of the lens implant to greatly decrease the dependence on glasses compared to traditional surgery.
Typically, the Multifocal Lens is then placed in the eye which represents the latest development in lens technology. These lenses are able to simultaneously focus light from both far away and near objects. This allows people to not only greatly reduce their dependence on glasses for far away vision but also for reading. While no technology is perfect, these lenses are the best solutions for simultaneous correction of distance and near vision without glasses for most people available at this time.