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Refractive Lens Exchange (RLE) - Clear Lens Exchange (CLE)

Alternative to Lasik, Bladeless Lasik, PRK, LASEK, Epi-Lasik, and P-IOL.

Diagram of intraocular lens implanted in an eye.  
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 to near.

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.

Personalized Answers

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.

Recent Refractive Les Exchange Medical Journal Articles...

Visual outcomes and patient satisfaction after refractive lens exchange with a single-piece diffractive multifocal intraocular lens.

J Ophthalmol. 2014;2014:458296

Authors: Chang JS, Ng JC, Chan VK, Law AK

Purpose. To report visual outcomes and patient satisfaction after unilateral or bilateral refractive lens exchange (RLE) with a single-piece bifocal diffractive multifocal intraocular lens (MIOL). Methods. All patients underwent RLE with the ZMB00 MIOL (Abbott Medical Optics). Patient charts were reviewed to evaluate the distance, intermediate, and near visual acuity (VA), contrast sensitivity, extent of visual symptoms (0-5), satisfaction (1-5), and rate of spectacle independence between unilateral and bilateral RLE group. Results. Forty-seven eyes of 28 patients were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate (67 cm), and near (30 cm) were 0.01 ± 0.12 (standard deviation), 0.27 ± 0.18, and 0.15 ± 0.11, respectively. No eyes lost >1 line of corrected distance VA. Monocular contrast sensitivity remained at normal level. Median scores of halos, night glare, and starbursts for 27 patients were 2.0, 3.0, and 0.0, respectively. Median score of satisfaction was 4.0. There were no differences in visual symptom scores or satisfaction between unilateral and bilateral group (P > 0.05). Eighty percent of 25 patients reported total spectacle freedom, with similar rate between bilateral (82%) and unilateral group (75%) (P = 1.000). Conclusions. RLE with the bifocal diffractive MIOL was safe in presbyopic patients and resulted in a high rate of spectacle independence.

PMID: 25505974 [PubMed]


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