|Refractive Lens Exchange (RLE) replaces the natural crystalline
lens of the eye is with an artificial lens that is hidden
behind the iris.
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, Bladeless Lasik, PRK, LASEK, Epi-Lasik if the patient is presbyopic.
Exchange The Natural Lens
In RLE the natural lens of the eye is removed and replaced with
a silicone or plastic intraocular lens (IOL). The replacement IOL is of a power to
correct most, if not all, of the patient's hyperopia or myopia. RLE can correct astigmatism if a toric IOL is used. To correct residual myopia, hyberpoia, or astigmatism, conventional or custom
wavefront Lasik, Bladeless Lasik, PRK, LASEK, or Epi-Lasik may be required in addition to RLE.
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, Bladeless 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
A big disadvantage with RLE is that it is a significantly more
invasive surgery than any cornea-based refractive surgery or even P-IOLs. An extremely myopic patient would have an elevated risk
of vitreous or retina problems after RLE.
An RLE patient will lose all natural 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 Crystalens do have the ability to provide a limited range of accommodation.
You may also have multifocal IOLs such as the ReSTOR and the ReZoom implanted that help with near and distance vision. You
will need to discuss with your doctor 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. There is little need to have surgery affecting the
cornea if within a short period of time you will be having cataract
surgery anyway or you already cannot change focus from distance
Perhaps A Cataract Surgeon, Not Lasik Surgeon
Something important to note is that RLE is often not performed
by refractive surgeons who specialize only in cornea based conventional
or custom wavefront Lasik, Bladeless Lasik, LASEK, PRK, Epi-Lasik,
and CK. RLE is very different from these procedures. For this reason,
a Lasik doctor may not even mention RLE, let alone provide it. For
successful RLE, you may find it necessary to locate a good cataract
doctor or select a doctor who has both extensive cataract experience
and extensive cornea-based refractive surgery experience.
Looking For Best Lasik Surgeon?
If you are ready to choose a doctor to be evaluated for conventional
or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization.
Locate a USAEyes Evaluated & Certified Lasik Doctor.
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