What is Refractive Lens Exchange (RLE)?
Refractive lens exchange, also called lens replacement surgery or clear lens extraction, may be a better option than LASIK, PRK or phakic IOL refractive surgery for people with presbyopia and high hyperopia (farsightedness).
Refractive lens exchange (RLE) replaces your eye’s clear natural lens with an artificial intraocular lens (IOL) to correct your refractive error and achieve sharper focus, reducing your need for reading glasses or bifocals. While lens replacement surgery technically does not have FDA approval, some eye surgeons will perform the procedure off label in certain circumstances. This is legal and sometimes is the most effective way to correct particular vision problems. RLE is typically reserved for people who are both farsighted and presbyopic (reading glasses-dependent)
Who is a Strong RLE Candidate?
Refractive lens exchange typically is for people with presbyopia or extreme farsightedness, for whom LASIK, PRK or phakic IOL surgery generally are not suitable. If you have both presbyopia and moderate to severe hyperopia, RLE may be the only viable option for clear vision and minimal reliance on glasses after refractive surgery.Lens replacement surgery also can correct myopia (nearsightedness), but generally it is not recommended when LASIK, PRK or phakic IOLs are available.
The RLE Procedure
The procedure for refractive lens exchange is virtually identical to cataract surgery. The difference is that in RLE, the lens being replaced is clear, rather than a cloudy lens due to a cataract.
As in cataract surgery, three types of IOLs are available to replace your natural lens, depending on your vision needs and the health of your eyes. They are:
- Monofocal fixed-focus IOLs: Monofocal lenses provide clear vision at distance, intermediate or near ranges — but not all three at once. Toric IOLs to correct astigmatism also are classified as monofocal IOLs.
- Multifocal IOLs: A multifocal lens provides clear vision at multiple distances.
- Accommodating IOLs: An accommodating IOL is a type of monofocal lens that enables focus at multiple distances by shifting its position in the eye. With intraocular lenses, there is no “one size fits all,” and your eye surgeon will recommend an IOL that is most suitable for your individual needs.
Refractive Lens Exchange vs. LASIK at the USC Roski Eye Institute
While LASIK remains the most popular option for correcting myopia and hyperopia, if you have a very severe refractive error or an abnormal cornea, lens-based refractive surgery such as clear lens extraction or phakic IOL implantation may be a better alternative.
Unlike LASIK or PRK, refractive lens exchange can correct almost any degree of hyperopia, and visual acuity after RLE surgery often is better than LASIK and PRK outcomes in cases of moderate and high hyperopia.
If you have myopia, RLE usually is performed only if you are not a suitable candidate for any other vision correction surgery. People with myopia have a higher risk of retinal detachment during clear lens extraction, and other refractive surgery options should be explored first.
Also, you should consider carefully the cost of RLE. Lens replacement surgery is about double the cost of LASIK surgery and typically is not covered by vision insurance.