Refractive Lens Exchange (RLE)

If you have presbyopia or suffer from severe farsightedness (hyperopia), you may not be a good candidate for some of the more common corrective procedures like PRK, LASIK or phakic IOL surgery. Refractive lens exchange (RLE) to the rescue.

Also referred to as clear lens exchange or refractive lensectomy, RLE is a surgical procedure that involves removing the natural lens of the eye and replacing it with an artificial intraocular lens (IOL). This might sound like a similar procedure to cataract surgery. That’s because it is. RLE is essentially the same procedure without the presence of a cataract. Like LASIK and other modern eye surgeries, refractive IOLs have allowed millions of patients to achieve 20/20 vision or better without the need for corrective lenses.

RLE Procedure – What’s Involved in Treatment?

Removal of the eye’s natural lens and replacement with an IOL sounds like a very involved surgery. So it might surprise you to learn that the procedure only takes 15 minutes per eye, and is performed on an outpatient basis.

As mentioned, the procedure itself is essentially identical to cataract surgery and involves removing the natural lens of the eye and replacing it with one of three IOL varieties:

  1. Monofocal IOL
  2. Multifocal IOL
  3. Accommodating IOL

Monofocal IOLs are the most basic option, providing clear vision for a single distance type (near, intermediate or far). Multifocal IOLs are premium lenses that provide correction across multiple distances at fixed points. Accommodating IOLs are the most advanced, and allow clear vision across all distances; near, intermediate, far and every point in between. Your eye surgeon will help determine the best IOL option for your specific needs during your consultation.

To perform RLE, your surgeon will apply numbing eye drops that will minimize any discomfort. If you are have IOLs implanted in both eyes, you will not be able to have treatment on the same day. Each eye must be treated separately one or two weeks apart.

Recovering from RLE

You will not be able to drive yourself home after treatment, meaning you will need to arrange a ride after your surgery. Most people are able to resume normal activity (including driving) within a week of RLE.

Improved vision should be immediate for most patients, but total corrective benefits may not be fully realized for several weeks. During this recovery period, it’s not uncommon for patients to experience issues like glare, halos, blurred vision and mild discomfort as the eye heals.

Benefits of RLE

Refractive lens exchange may benefit you in a number of potentially life-changing ways.

If you don’t have cataracts but you do have severe myopia (nearsightedness) or hyperopia (farsightedness), your surgeon has probably informed you that you are not a good candidate for LASIK. But thanks to options such as RLE, you too can enjoy the transformative benefits of refractive surgery. Similarly, if you are not a good candidate for LASIK due to thin corneas, RLE is a viable alternative.

Surgery to implant refractive IOLs also offers the following benefits:

  • Quick recovery
  • Doesn’t alter corneal thickness (unlike laser vision correction) and therefore eliminates some potential complications
  • No need for cataract surgery in eye(s) treated with RLE in the future
  • No risk of losing corrective effect (unlike laser vision correction)
  • Can correct presbyopia (age-related farsightedness)

Risks & Complications

All surgical procedures have some associated risk, including those involving RLE. Many of the risks differ from those associated with LASIK because refractive IOLs are implanted deeper in your eye than the area treated in LASIK.

There are more risks associated with refractive lens exchange than with LASIK. As a result, your surgeon is unlikely to recommend that you have RLE unless you have a high prescription for myopia or hyperopia.

Here are some of the risks of RLE:

  • Glaucoma
  • Infection
  • Retinal detachment
  • Over-correction
  • Under-correction
  • Bleeding
  • IOL dislocation
  • Posterior capsular occlusion (i.e., a new cataract forms)

Are You a Candidate?

You must be 21 years old or older to be considered a good candidate for RLE. In addition, you must have stable vision for the six months leading up to your procedure, and you must have healthy eyes, with no history of eye disease. Finally, it is important that you understand and accept the risks associated with procedures involving the implantation of refractive IOLs.

Many experts believe that the best candidates for refractive lens exchange are people with moderate to high farsightedness, and those with farsightedness who are over age 45 and have presbyopia (the latter have a lower risk of retinal detachment than people with high myopia).

If you have a condition that is more readily correctable with LASIK or PRK, your doctor will likely urge you to consider these more conservative alternatives.

Cost of Refractive Lens Exchange

Refractive lens exchange is considered an elective procedure, so it is not covered by insurance. It typically costs more than LASIK and other laser vision correction procedures. Expect to pay around $4,000 per eye, or more. If this sounds prohibitive, you likely still have options; look into whether your company offers a Flexible Spending Account (FSA) or Health Savings Account (HSA), and many practices offer financing options.

How does the cost of RLE compare with the cost of cataract surgery? The pricing is pretty similar. Based on recent estimates, the average per-eye cost of cataract surgery is $3,500. While cataract surgery with a monofocal IOL is usually covered by Medicare (which can cover upwards of $2,800 of standard cataract surgery), supplemental insurance for people with Medicare, and often by private health insurance or vision insurance, if you have refractive cataract surgery with a premium IOL — one that corrects astigmatism or presbyopia, or allows you see clearly at multiple distances without corrective lenses — you will pay the difference. Make sure you speak to your doctor and your insurance company about the cost before proceeding with surgery.