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Refractive Lens Exchange

Refractive Lens Exchange (RLE) is a vision correction lens surgery designed to reduce or eliminate the need for glasses and/or contact lenses for people over the age of 40.

What is Refractive Lens Exchange?

Unlike LASIK, SMILE, or PRK, which reshape the cornea and don’t alter any other structure of an eye, RLE involves the same steps as the cataract surgery. The only difference is there is no visually significant cataract. After age 40, most people notice difficulty focusing at near. This is because a natural crystallin lens gradually loses its elasticity, its ability to focus at various distances, over a lifetime. This loss of elasticity becomes noticeable in early 40s. In RLE, the relatively clear natural lens is replaced with the advanced artificial intraocular lens (IOL), which enables simultaneous vision at far, intermediate, and near objects without glasses or contacts. Both eyes have to undergo RLE to substantially reduce the need for glasses and/or contact lenses.

As with any invasive surgery, there are several risks to consider. The following list of RLE complications is not comprehensive, but it includes most serious and most common complications.

If you have large eyes (ie, moderate or high myopia (nearsightedness) or a prescription of – 5.0 or more negative), there is 5% to 10% risk of a retinal detachment within the first 5 years of RLE. This is a potentially a sight-threatening complication and requires an emergency major surgery to re-attach the retina. Even if the retina is reattached, there is a possibility of permanent loss of vision.

This is a sight-threatening infection, though it is extremely rare, occurring approximately 1 in 20,000 cases when intraocular antibiotic is used prophylactically.

Significant inflammation in an eye after lens surgery is rare. However, very rarely it can be severe and chronic, requiring lifelong use of eye drops, injection of medicines into an eye, and/or immunosuppressive systemic (oral or injectable) medications with serious potential side effects.

This sight-threatening condition is exceptionally rare. Unfortunately, there is no effective treatment for it. It is more common in eyes with very large prescription and high intraocular pressure.

If you don’t see them now, you will likely see them after RLE. The good news is they usually become rarely noticeable after several months. Floaters never physically disappear, but the brain usually learns to ignore them. For a small percentage of patients, floaters are very disturbing for many months and even years, requiring laser treatment and even invasive vitreal surgery.

This is a wrinkling of the central retina, which can lead to distorted vision and require a major surgery to correct it. This complication can happen because the gel in an eye called vitreous separates from the retina during or after refractive lens exchange surgery. This vitreous detachment, in turn, creates conditions for a membrane to form on a macula.

This swelling of the central retina usually resolves with eye drops without long lasting effects on vision. However, rarely it can be long lasting and significantly decrease vision, requiring injections of medicines into an eye.

This is a clouding of a lens capsule that houses the IOL, occurring within the first 3 years of surgery. It is very common after RLE, occurring in more than half of patients 40-60 years old, and is successfully treated in an office with a YAG laser. Nonetheless, there is a very small risk of retinal detachment after YAG laser cutting of the cloudy capsule.

Bottom line: the benefits and risks of RLE depend on the unique features of your eyes, and a more individualized estimate of your risk requires a thorough eye exam and a battery of diagnostic measurements.

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