Refractive Lens Exchange (RLE)

Medically reviewed by Milan Patel, M.D.

What is Refractive Lens Exchange?

Refractive Lens Exchange (RLE) or Clear Lens Exchange (CLE) is a surgical procedure for people who are over the age of 40 and may be experiencing new visual changes. RLE eye surgery can be used to correct presbyopia, nearsightedness, or farsightedness and is an alternative to LASIK.

For patients younger than the early or mid-40’s, LASIK can often be the best choice for vision correction. It is a procedure that is performed on the surface of the eye and, therefore, is less invasive and often less expensive than other procedures. However, when people reach their mid-40s and 50s, the natural lens in the eye undergoes changes that can make RLE surgery a more logical choice for these patients. Refractive Lens Exchange surgery is very similar to cataract surgery in that your natural lens is removed and replaced with an intraocular lens (IOL) implant of your choice based on your vision needs.

RLE vs LASIK

With LASIK and Refractive Lens Exchange, depending on your age, the results are quite similar but the procedures can vary significantly.

During a LASIK procedure, an incision is made in the cornea to create a flap of tissue. This flap is then lifted, and a laser is applied to the underlying corneal bed to reshape the cornea. The flap is then put back into its original position and allowed to heal naturally over the next several days. Antibiotic and steroid drops are used post-operative for a short period of time to aid in healing.

A significant advantage of Refractive Lens Exchange surgery for patients is that they will no longer need cataract surgery in the future. Barring development of other eye diseases, there is the potential of lifelong good vision without glasses. This has significant appeal for patients who do not want to have LASIK, only to need another procedure 10 or 15 years later. Additionally, for patients with glaucoma or elevated intraocular pressure, Refractive Lens Exchange surgery has the added effect of lowering intraocular pressure and it is bundled with the ability to place different lens options to ensure you are getting the vision results you want after surgery!

The RLE procedure has the same steps as cataract surgery, including removal of the natural lens and replacement with an artificial lens. The power of the artificial lens is selected to minimize the patient’s dependence on glasses. With a monofocal lens, patients can choose either near or distance vision, but with a multifocal lens, patients can achieve both near and distance vision thus lowering dependence on glasses.

The RLE procedure takes about 10-15 minutes per eye. It has little downtime with quick recovery, a predictable outcome, and results in an excellent quality of vision freeing you from using glasses or contacts. Desired outcomes are achieved within 1-2 days and you have the ability to resume normal activities in the same amount of time.

Why Choose Refractive Lens Exchange Surgery?

Long before the natural lens becomes a cloudy “cataract,” it is slowly becoming thicker, less flexible, and less clear. These changes, known as dysfunctional lens syndrome, can cause trouble with focusing for near vision, and create imperfections in the visual system called aberrations, that lead to increased glare and decreased the quality of vision.

If a patient in the age range of 40 to 50 years old has their vision corrected to see clearly in the distance with LASIK, they will still need glasses for reading. Also, since these patients are getting closer to the age where they will require cataract surgery, previous LASIK cause the calculations for the cataract surgery to become less accurate. For these reasons, it may be in these patients’ best interest to consider Refractive Lens Exchange surgery.

Risks of RLE

There are some risks with RLE eye surgery that are greater than the risks associated with LASIK. This is because LASIK is performed on the surface of the eye and RLE is a procedure that is performed inside the eye. Risks include intraocular infection, retinal tear or detachment, and swelling of the retina.

Is Refractive Lens Exchange Covered by Insurance?

While cataracts are considered medically necessary to remove in a procedure that is covered by insurance companies, Refractive Lens Exchange surgery may not be covered if insurance companies do not consider the situation severe enough to warrant paying for surgery to correct it. Additionally, the cost of RLE with a multifocal lens is generally higher than the cost for LASIK.

Additional RLE Eye Surgery Resources:

PubMed
Centers for Medicare & Medicaid Services
American Academy of Ophthalmology