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Refractive Lens Exchange (RLE)

Refractive Lens Exchange (RLE)

A Vision-Correcting Solution for Aging Eyes

More than 6 out of every 10 Americans depend on eyeglasses or contacts to be able to see clearly enough to work, drive, and accomplish daily activities. If you’re one of these people, and you want to wake up and see clearly without reaching for your glasses, LASIK eye surgery at Whitson Vision in Indianapolis and Avon, Indiana, may be your ideal solution. William E. Whitson, MD, specializes in state-of-the-art LASIK eye surgery to correct common eye disorders and decrease or eliminate your dependency on glasses. To find out if you’re a candidate for LASIK eye surgery, call or schedule a consultation online.

One of the first things that slaps us in the face as we age is the slow but progressive change in our ability to focus on close objects. This generally begins around age 40, a bit sooner for women and a bit later for men, simply because men have longer arms and can hold things a bit further away from their eyes. This is what results in our need to begin using reading glasses or “cheaters”. It is caused by the slow hardening of the lens of our eye which does not allow the lens to easily change shape (focus) as it had been doing all of our life up to that point. This loss of reading ability is known as Presbyopia. Another term for this process is Dysfunctional Lens Syndrome. This is the first step in the lens of our eyes that eventually leads to Cataract formation in our 60’s and 70’s. 

This process affects all of us, but does so differently depending upon many factors. For people who are very used to the ability to read without glasses, they can become unhappy with the prospect of needing to keep track of those darn reading glasses, People who are farsighted will begin to even lose their uncorrected distance vision and will now require full time spectacle wear. 

The good news is that there are options available that can improve those negative visual symptoms. While Lasik surgery can improve the base or natural refractive state of the eye, it cannot restore the focusing ability of the lens that we lose as we age. Fortunately, there is a different procedure that can improve our ability to regain some of the visual distances that we lose over time. If you’re seeking a long-term vision solution and are looking to reduce or eliminate the need for glasses or contact lenses, Refractive Lens Exchange (RLE) could be the answer. RLE is a sophisticated procedure tailored to patients who may not be ideal candidates for LASIK but still want the freedom that clearer, unassisted vision can provide.

What is Refractive Lens Exchange?

Refractive Lens Exchange, also known as RLE, is a surgical procedure designed to replace the eye’s natural lens with an artificial one, known as an intraocular lens (IOL). Similar to cataract surgery, RLE corrects vision by addressing the eye’s focusing power, but instead of targeting cloudiness in the lens (as with cataracts), RLE is designed to replace a dysfunctional lens with an IOL chosen to provide or restore the visual distances lost to aging. RLE is purely focused on enhancing vision for those who struggle with age-related changes like presbyopia or high refractive errors.

Who is an Ideal Candidate for RLE?

RLE is a popular choice among patients who are over 40 and experience presbyopia, or age-related farsightedness, and those with high refractive errors that are challenging to correct with LASIK or PRK. Patients typically seeking RLE are motivated to minimize their reliance on glasses or contact lenses and want a more permanent vision solution. This procedure is particularly beneficial if you:

  • Are over 40 and have presbyopia, making reading up close difficult.
  • Have hyperopia (farsightedness), which can cause difficulty focusing on nearby objects.
  • Are looking for a vision correction option that won’t be affected by future cataracts.

If you’re generally healthy, have stable eye conditions, and do not have uncontrolled eye diseases, you may be an excellent candidate for RLE.

The Benefits of Choosing RLE

One of the standout benefits of RLE is the opportunity to achieve clear vision without the need for reading glasses or bifocals, something that’s especially appealing to those who are tired of juggling different prescriptions. The benefits of RLE extend beyond just convenience:

Reduced Dependency on Glasses or Contacts

RLE can significantly reduce or even eliminate your reliance on glasses or contacts for most daily activities.

Permanent Cataract Prevention

Since the eye’s natural lens is removed, you will never develop cataracts. This makes RLE a two-in-one solution for vision improvement and cataract prevention.

Customized Vision Solutions

With a range of IOL options available, you and your doctor can choose a lens that best meets your vision needs, from monofocal lenses that sharpen distance vision to Multifocal or the Light Adjustable Lens that can provide focus at multiple distances.

How Does RLE Differ from LASIK and Cataract Surgery?

While LASIK reshapes the cornea to improve vision, RLE replaces the natural lens, offering a solution for people whose eye shape or prescription make them unsuitable for LASIK. It also differs from cataract surgery, which is primarily performed to remove a cloudy lens due to cataracts. With RLE, the focus is on correcting refractive errors before cataracts develop, giving you an alternative to ongoing lens wear.

Understanding the Intraocular Lens (IOL) Options

One of the defining aspects of RLE is the variety of intraocular lens options available, each designed to cater to different vision needs. Together with your doctor, you can select the IOL type that best matches your lifestyle and visual goals:

Monofocal IOLs

These lenses provide clear vision at one fixed distance, usually optimized for distance, so you may still need glasses for reading or other close-up tasks.

Multifocal IOLs

Multifocal lenses have multiple focal points to help with vision at various distances. This type of IOL is popular for patients who want to minimize or eliminate their need for glasses altogether.

Extended Depth of Focus (EDOF) IOLs

These lenses offer a broader range of vision compared to monofocal lenses, providing good distance and intermediate vision with minimal halo effects and glare.

Light Adjustable Lens (LAL)

This is a very special IOL that offers the ability to customize or “fine-tune” the power of the lens after it is already in the eye for a week or two and we know exactly what power changes might be helpful to maximize the patient’s vision.

Choosing the right IOL is a personalized decision that you and your doctor will make based on your visual demands, lifestyle, and any specific vision correction needs. Not every IOL is necessarily a good fit for every patient. This is why choosing an eye care provider who has the knowledge and experience to help you choose wisely is so important. We, at Whitson Vision, have that knowledge and experience and can bring it to bear for you.

What to Expect Before, During, and After RLE

Before surgery, you’ll have a thorough eye exam to determine your eye health, prescription, and whether RLE is a good fit. Prior to that initial examination you may be asked to stop wearing contact lenses, generally for about one week. This is to allow your cornea to relax from any contact lens-induced curvature changes that could alter the measurements needed to accurately select the IOL power. The doctor and staff will also discuss IOL options with you, helping you make an informed decision. 

RLE is an outpatient procedure, meaning you’ll be able to go home the same day. The surgery itself typically takes about 15-20 minutes per eye. You will receive a mild relaxing medication and anesthetic drops. A small incision is made in the cornea and the lens is then removed from the eye, similar to how cataract surgery is performed. Your doctor will then place the selected IOL in the eye. The process is quick and essentially painless. 

The initial recovery from RLE is generally short, with most patients noticing improved vision within a few days. It is normal to experience some mild discomfort, sensitivity to light, or slight blurriness as your eyes heal and adjust to the new lens. Your doctor will provide detailed post-operative care instructions, including using prescribed eye drops and avoiding strenuous activities for a short time.

While healing times can vary, most patients find that their vision stabilizes and reaches its full potential within a few weeks.

Similar to cataract surgery, RLE is a safe and widely performed procedure, but like any surgery, it carries some risks. Fortunately, complications are rare. A detailed discussion of potential risks will be carried out during your office visit, as is our practice for any of the surgical procedures we perform. Your doctor will review any relevant health conditions that could affect healing and go over the steps we take to ensure a smooth recovery.

One of the biggest advantages of RLE is that it’s designed to be a permanent solution. Since the artificial lens will not change shape or clarity over time, the results are typically stable and long-lasting. About 50% of lens-based procedures may eventually develop some haze to the membrane behind the IOL. This is called posterior capsule opacification and is easily and simply corrected with an insurance covered YAG procedure in the office. The eye is almost always restored to the pre-haze level of vision following the laser treatment.

RLE offers a valuable solution for those seeking an alternative to glasses, contacts, or even LASIK. While it is not for everyone, if you are over 40 and want to address presbyopia, farsightedness, or a high refractive error, RLE may be an ideal choice for you. Your doctor will assess your vision, discuss the benefits and risks, and work closely with you to determine if RLE is the best approach for your vision goals.

Moving Forward with Confidence

Choosing to undergo Refractive Lens Exchange is a significant step toward achieving greater freedom from glasses and contacts. By offering a customized, lasting solution for your vision, RLE can help you embrace a future with clearer sight.