Refractive lens exchange (RLE), also called “clear lens extraction”, may be a better option than PRK Surface LASIK or Implantable Contact Lenses for people with presbyopia and high hyperopia (farsightedness).

RLE replaces your eye’s natural lens with an artificial intraocular lens (IOL) to correct your refractive error and achieve sharper focus, reducing your need for reading glasses, bifocals or progressive lenses.

The procedure for RLE 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 a bonus, patients who have RLE surgery will never develop a cataract, as the natural lens where a cataract would develop has been removed.

As in cataract surgery, two types of IOLs are available to replace your natural lens, depending on your vision needs and the health of your eyes. They are:

• Monofocal 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. These implants are highly specific and customised to the individual, providing clear vision at distance, intermediate and near simultaneously. They can also be used to correct astigmatism.

  These implants work differently from multifocal/progressive prescription glasses, in which the prescription changes from the top to the bottom of the lens. In Multifocal IOL implants, the powers are distributed in concentric rings throughout the lens. This allows independence from glasses for all viewing distances without the need for conscious thought about head or eye positions.

The pre-op workup for RLE patients is a crucial component to ensuring the desired visual outcome is achieved. A number of highly specialised instruments are used to collect precise information about your eye, which allows for accurate calculation of the intraocular lens that will be placed in the eye during surgery.

We encourage patients to who wish to understand more about their options for post refractive surgery vision outcomes to make an appointment with our Clinical Optometrists for further discussions.

Refractive Lens Exchange usually takes about 15 minutes and is performed on an inpatient day procedure basis. Each eye is done separately. There are no stitches or patches required during the surgery. Recovery is about 48 hours off work and 2 weeks off strenuous exercise.

Numbing anaesthetic drops and twilight anaesthesia are used during RLE, so typically there is no discomfort, and most people report immediate vision improvement after surgery. Full vision recovery takes about 48 hours once the pupils have returned to a normal size again.

Final visual outcomes of RLE can take up to several weeks, and you may notice vision disturbances such as blurry vision, halos and glare, or a “scratchy” sensation as your eyes heal. You should be able to return to work and resume driving within a week of surgery, dependent on the individual circumstances.

Normally, you won’t feel an IOL in your eye, in the same way that you don’t feel a dental filling for a cavity. Also, since the IOL is situated inside your eye and not on the surface like a contact lens, it is not visible to the naked eye.

The artificial IOL is a permanent replacement for your natural lens and is designed to last the rest of your life. Additionally, as IOLs are not affected by age-related changes, there is minimal risk of regression (loss of corrective effect or deterioration of vision) over time.