Laser vision correction
- Reshapes the front surface of the eye; the natural lens stays in place
- Suits many younger eyes with a stable prescription
- Does not address the loss of near focus that comes with age
- Not an operation inside the eye
Refractive
lens exchange
What refractive lens exchange (RLE) is, who tends to consider it, how suitability is assessed, and the risks and limitations to weigh.
What refractive lens exchange is.
Refractive lens exchange replaces the natural lens of the eye with an artificial lens before a cataract has formed, to change the focus of the eye and reduce dependence on glasses.
The operation is the same as modern cataract surgery: through a very small opening the natural lens is removed and a folded intraocular lens (IOL) is placed in its position. What differs is the reason. In cataract surgery a cloudy lens is removed because it is affecting vision. In RLE a clear lens is removed by choice, which makes the decision an elective one and the suitability conversation more important, not less.
Dr Chen approaches RLE conservatively. It suits some eyes well, and for others glasses, contact lenses or laser vision correction remain the better choice; he will say so.
In brief
- Lens-replacement surgery, the same operation as cataract surgery
- Performed before a cataract, for refractive reasons
- Elective: the eye is otherwise healthy
- The lens design chosen sets what vision to expect
- Not suitable for every eye; alternatives are discussed
Who considers it
Where RLE sits among the options.
People usually arrive at RLE after weighing glasses, contact lenses and laser vision correction. This is how the three approaches differ.
Refractive lens exchange
- Replaces the clear natural lens with an artificial intraocular lens (IOL)
- Considered for the age-related loss of near focus or for high prescriptions, often once laser has been ruled out
- The same operation as cataract surgery, chosen for a different reason
- Carries the risks of surgery inside the eye, and the lens has to be chosen with care
Cataract surgery
- Replaces a lens that has become cloudy
- The same lens designs and the same trade-offs apply
- Treatment for a condition rather than an elective change
- A cataract will not develop in the artificial lens afterwards
Educational comparison only. Which option, if any, suits an eye is decided at the consultation.
At the consultation
How suitability is assessed.
The assessment looks at the whole eye, because RLE is only sensible when the rest of the eye is healthy and the expectations are realistic.
Measurements of the length and curvature of the eye (biometry) predict the lens power. A map of the cornea shows astigmatism and any irregularity, and whether earlier laser treatment has changed it. The surface of the eye is checked for dryness, which affects both the measurements and the result. An OCT scan (optical coherence tomography) of the macula and a dilated examination of the retina confirm the back of the eye is healthy; this matters particularly in short-sighted eyes, which carry a higher risk of retinal detachment after lens surgery.
Because Dr Chen works across both the lens and the retina, the retinal side of that assessment is part of the same conversation rather than a separate referral.
Talked through at the consultation
- What you want your vision to do: reading, screens, driving, sport
- How you feel about glasses for some tasks
- Your tolerance of haloes or glare at night
- The health of the retina and cornea
- The alternatives, including doing nothing
The lens
Which lens goes in.
RLE stands or falls on the lens choice, because the lens sets the focus of the eye for good.
Monofocal, toric, extended-depth-of-focus and multifocal designs each place focus at different distances and carry different trade-offs. The comparison, with a diagram of which distances each design typically brings into focus, is on the lens choices page. The choice follows the eye first, then what you want your vision to do.
Compare the lens designs →Common pairings
- One eye set for distance and the other for nearer vision (monovision), usually with monofocal lenses
- Toric versions of any design where astigmatism needs correcting
- Extended-depth or multifocal designs where the eye and the person suit them
Which pairing suits an eye is decided at the consultation; none is promised in advance.
Risks and limitations
Stated plainly.
RLE carries the risks of cataract surgery, applied to an eye that could otherwise have waited.
- Surgical risks. Infection, bleeding, swelling of the macula or cornea, raised pressure and, rarely, loss of vision. Retinal detachment is uncommon but more likely in highly short-sighted eyes.
- Glasses may still be needed for some tasks, depending on the lens design and how the eye settles.
- Night-time effects. Haloes or glare around lights with some lens designs, which most people adapt to and some do not.
- Adaptation. Multifocal and extended-depth designs ask the brain to adjust; a few people never feel comfortable with them and, in selected cases, the lens is exchanged.
- Later haze on the capsule behind the lens, cleared with a brief laser treatment.
- Not reversible in the ordinary sense: the natural lens cannot be put back, although the artificial lens can be exchanged in selected circumstances.
Who RLE may not suit
- Eyes with macular disease, an epiretinal membrane or other retinal problems
- Younger eyes that still focus well up close
- Corneal irregularity or significant dryness
- People who want a guarantee of no glasses
General information, not a guarantee of outcome. Suitability is decided at the consultation.
Questions to ask
Useful questions for the consultation.
- Am I a suitable candidate, and what in my eyes makes you say so?
- What are the alternatives for me, including glasses, contact lenses or laser vision correction?
- Which lens design do you recommend for my eyes, and why?
- Will I still need glasses for some tasks?
- What are the risks for my eyes in particular, including to the retina?
- What is realistic for night driving with the lens you recommend?
- What happens if I am not happy with the result?
Bring these, and anything else on your mind. Write the answers down, or bring someone who can.
Common questions
Straight answers, without replacing a consultation.
How is RLE different from cataract surgery?
The operation is the same; the difference is the reason. In cataract surgery a cloudy lens is removed. In RLE a clear lens is removed to change the focus of the eye and reduce dependence on glasses.
How is it different from laser vision correction?
Laser reshapes the cornea and leaves the natural lens in place. RLE replaces the lens, so it can address the age-related loss of near focus and higher prescriptions, but it is an operation inside the eye with a different set of risks.
Will I need cataract surgery later?
No. The artificial lens does not develop a cataract. Some people later need a brief laser treatment if the capsule behind the lens becomes hazy.
Is RLE right for a short-sighted eye?
It can be, but highly short-sighted eyes carry a higher risk of retinal detachment after lens surgery, so the retina is examined carefully and the trade-off is discussed openly.
Can both eyes be done together?
Usually one eye at a time, a short interval apart, so the first result can inform the plan for the second.
Ready when you are.
Appointments and enquiries through Vision Eye Institute, Chatswood.
Free Chinese Patient Liaison for VEI Sydney patients. Chinese language support through VEI (02) 9052 1886