Refractive Lens Exchange

Refractive Lens Exchange: A Comprehensive Guide to Vision Correction


Welcome to our comprehensive guide on refractive lens exchange (RLE), an advanced vision correction procedure that offers long-lasting results. In this article, we will discuss the process, benefits, and risks of RLE, as well as the ideal candidates and types of intraocular lenses available. Our goal is to provide you with the most up-to-date and accurate information, empowering you to make an informed decision about your eye care.

What is Refractive Lens Exchange?

  • Refractive lens exchange is a vision correction eye surgery that involves replacing the natural lens of the eye with an artificial intraocular lens (IOL).

  • This new, lens replacement surgery is designed to correct severe refractive error or errors such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.

  • The primary goal of RLE is to help patients achieve clearer vision and reduce their dependency on glasses or contact lenses, my correcting significant refractive errror.

Benefits of Refractive Lens Exchange

RLE offers several advantages over other laser vision correction methods:

  • Long-lasting results: RLE provides a permanent solution for vision correction, eliminating the need for glasses or contact lenses.

  • Versatility: RLE is effective for a wide range of refractive errors, including high degrees of nearsightedness, farsightedness, and astigmatism.

  • Presbyopia correction: RLE can address age-related near vision loss (presbyopia), improving both near and distance vision.

  • Cataract prevention: By replacing the natural lens, RLE eliminates the possibility of developing cataracts in the future.

Comparison with Other Vision Correction Procedures (LASIK, PRK, ICL)

Refractive lens exchange (RLE) can be compared to other vision correction procedures, such laser eye surgery such as LASIK, PRK, and ICL, in terms of technique and approach:

  • LASIK (Laser-Assisted in Situ Keratomileusis): This procedure involves creating a flap on the cornea and reshaping the underlying corneal tissue using an excimer laser. It is primarily used to correct nearsightedness, farsightedness, and astigmatism.

  • PRK (Photorefractive Keratectomy): PRK is a predecessor to LASIK, and also involves reshaping the cornea using an excimer laser. However, PRK does not involve creating a corneal flap, making it a suitable option for those with thin corneas.

  • ICL (Implantable Collamer Lens): This procedure involves implanting a phakic intraocular lens (IOL) without removing the eye’s natural lens. ICL is primarily used to correct nearsightedness and can be a good option for patients who are not candidates for corneal-based procedures.

RLE, or lens replacement surgery on the other hand, directly addresses the lens of the eye, making it an excellent vision correction and lens replacement surgery option for individuals who may not be candidates for corneal-based procedures or those with a higher risk of cataract development.

By comparing the techniques and approaches of RLE, LASIK, PRK, and ICL, patients can better understand the options available to them and make informed decisions about their vision correction needs.

Who is a Candidate for RLE?

Ideal candidates for refractive lens exchange (RLE) are individuals who may not be suitable for other vision correction procedures such as LASIK or PRK. Some factors that may make RLE a better choice for a patient include:

  1. Significant refractive errors: RLE may be recommended for patients with high levels of myopia (nearsightedness), hyperopia (farsightedness), or astigmatism that cannot be adequately corrected with other procedures.

  2. Thin corneas: LASIK and PRK involve reshaping the cornea, which may not be suitable for patients with thin or irregular corneas. In such cases, RLE may be a more appropriate option.

  3. Early signs of cataracts: Patients with early cataract development may benefit from RLE, as the procedure can address both vision correction and cataract removal simultaneously.

  4. Dysfunctional Lens Syndrome and Early Signs of Cataracts

    Dysfunctional lens syndrome (DLS) is a condition that affects the natural lens of the eye, typically as part of the aging process. It is characterized by a gradual decline in lens function, which can eventually lead to the development of cataracts. DLS can manifest through a range of symptoms and signs, some of which overlap with early cataract formation.

    Early signs of DLS and cataracts may include:

    1. Cloudy or blurry vision

    2. Loss of near vision (presbyopia) due to the lens becoming stiffer and losing focusing power

    3. Development of higher-order aberrations, which can affect overall visual quality

    4. Decreased contrast sensitivity, making it more challenging to distinguish between shades of gray

    5. Glare and halos, particularly noticeable when driving at night

    DLS progresses through different stages as a person ages, with symptoms becoming more severe over time. In the later stages of DLS, the lens may become increasingly opaque, leading to the formation of visually significant cataracts that severely degrade vision.

    Patients experiencing early signs of cataracts or DLS may choose to undergo cataract surgery or refractive lens exchange (RLE) to address their vision issues. A thorough evaluation by an eye doctor or ophthalmologist is essential to determine the most suitable treatment option for each individual’s unique needs.

  5. Presbyopia: RLE can be an effective solution for patients experiencing age-related loss of near vision (presbyopia), as the procedure can replace the natural lens with a multifocal or accommodative intraocular lens (IOL) to improve both near and distance vision.

A thorough evaluation by an eye doctor or ophthalmologist is essential to determine whether RLE is the right choice for a patient’s unique needs. This evaluation typically includes a comprehensive eye examination, an assessment of the patient’s medical history, and a discussion of the patient’s vision goals and expectations. Based on this information, the eye care professional can make an informed recommendation on whether RLE or another vision correction procedure is the most suitable option.

Preparing for RLE Surgery

To ensure a successful RLE procedure, follow these steps:

  • Consultation: Schedule a thorough eye examination and consultation with a qualified eye surgeon to determine if you are a suitable candidate for RLE.

  • Medications: Discuss your current medications with your surgeon, as some may need to be stopped or adjusted prior to surgery.

  • Arrange transportation: Plan for a friend or family member to drive you to and from the surgery, as you will not be able to drive immediately after the procedure.

  • Follow pre-operative instructions: Adhere to your surgeon’s pre-operative instructions, which may include using antibiotic eye drops and avoiding makeup, lotions, and perfumes on the day of surgery.

Types of Lens Implants

Explore the various types of intraocular lenses (IOLs) available for refractive lens replacement, exchange and cataract surgery, each with their unique features and benefits. Some of the most popular IOLs include:

Monofocal IOLs

Monofocal lenses provide clear vision at a single distance, either near or far. They are the most basic and widely used type of IOL. Patients with monofocal lenses and reading vision may still need reading glasses for near tasks, such as reading or computer work. Examples of monofocal lenses include:

  • Alcon AcrySof IQ: This monofocal IOL offers sharp vision at a single distance and has an aspheric design that reduces spherical aberration, resulting in improved image quality.

  • Johnson & Johnson Vision TECNIS Eyhance: The Eyhance lens is a monofocal IOL designed to provide enhanced intermediate vision along with excellent distance vision. This lens aims to improve patients’ visual quality for daily tasks such as computer work and cooking, while still maintaining a high level of distance vision.

Multi-focal IOLs

Multifocal lenses offer clear vision at multiple distances, reducing or eliminating the need for glasses. They are designed with multiple concentric zones that focus light on the retina for near, intermediate, and far vision. Some popular multifocal IOLs are:

  • Alcon PanOptix: The PanOptix lens is a trifocal IOL that provides clear vision at near, intermediate and far distances. It uses ENLIGHTEN™ Optical Technology to optimize the distribution of light, resulting in high-quality vision across all distances.

  • Johnson & Johnson Vision TECNIS Symfony: This extended depth of focus (EDOF) lens provides a continuous range of vision, from near to far, and minimizes halos and glare, which can sometimes be associated with multifocal IOLs.

  • Alcon Vivity: The Vivity IOL utilizes X-WAVE™ technology to provide an extended range of vision while maintaining a low incidence of visual disturbances like halos and glare.

Toric IOLs

Toric lenses are designed to correct astigmatism in addition to nearsightedness or farsightedness. They have a unique shape that compensates for the irregular curvature of the cloudy lens and the cornea, which causes astigmatism. Some examples of toric IOLs include:

  • Alcon AcrySof IQ Toric: This toric IOL corrects astigmatism while providing clear distance vision. It features an aspheric design and a proprietary lens material that filters out harmful UV and blue light.

  • Johnson & Johnson Vision TECNIS Toric: The TECNIS Toric lens is designed to correct astigmatism and provide excellent vision quality at all distances. It is available in both monofocal and multifocal.

Preoperative Assessment and Preparation

Before undergoing RLE, most patients undergo a comprehensive preoperative assessment to ensure the procedure is suitable for them and to minimize potential complications. This process involves several important steps:

  1. Medical history review: The surgeon discusses the patient’s medical history, including any existing eye conditions or previous eye surgeries, to identify any potential risks or contraindications for RLE.

  2. Vision goals and expectations: The surgeon and patient discuss the patient’s vision goals and expectations to determine if RLE is the right choice for them, considering factors such as age, occupation, and lifestyle.

  3. Eye measurements: Accurate eye measurements are essential for selecting the most appropriate intraocular lens (IOL) for each patient. This includes measuring the curvature of the cornea, the length of the eye, and the depth of the anterior chamber.

  4. Diagnostic tests: A series of diagnostic tests are performed to evaluate the health of the eye and identify any potential complications. These tests may include corneal topography, optical coherence tomography (OCT), and measurements of intraocular pressure (IOP).

  5. Risk assessment: Based on the results of the preoperative evaluation, the surgeon assesses the potential risks and benefits of RLE for the patient, taking into account factors such as overall eye health, the presence of any coexisting eye conditions, and the patient’s general health status.

Once the preoperative assessment is complete, the surgeon and patient collaborate to develop a personalized treatment plan, which includes selecting the most suitable IOL and discussing any additional procedures that may be necessary, such as astigmatism correction or addressing other eye conditions.

Proper preoperative assessment and preparation are crucial for the success of RLE, as they help to ensure that the surgical procedure is the best option for the patient and minimize the risk of complications.

A step-by-step explanation of the RLE procedure

The RLE procedure involves the following steps:

  • Anesthesia: The surgeon administers a local anesthetic to numb the eye and may also provide a mild sedative to help the patient relax.

  • Incision: The surgeon creates a small incision in the cornea to access the natural lens.

  • Lens removal: The natural lens is carefully broken up using ultrasound energy and removed with a specialized instrument.

  • Lens implant: The surgeon inserts the artificial lens through the incision and positions it in the same location as the natural lens.

  • Incision closure: The incision is closed, usually without the need for stitches, as it self-seals.

The Recovery Process

The recovery process after RLE surgery involves the following steps:

  • Rest: Get plenty of rest and avoid any strenuous activities for at least a week following the procedure.

  • Eye protection: Wear protective eye shields or sunglasses as recommended by your surgeon to shield your eyes from bright light and debris.

  • Medication: Use prescribed antibiotics and anti-inflammatory eye drops to prevent infection and minimize inflammation.

  • Follow-up appointments: Attend all follow-up appointments with your eye surgeon to monitor your healing and ensure proper recovery.

  • Vision stabilization: Be patient, as it may take a few weeks for your vision to fully stabilize after RLE surgery.

Benefits of Refractive Lens Exchange

  • Improved vision: RLE can correct nearsightedness, farsightedness, and astigmatism, providing clearer vision without the need for glasses or contact lenses.

  • Treatment for presbyopia: RLE can treat presbyopia, a common age-related condition that makes it difficult to focus on close objects.

  • Prevention of cataracts: By replacing the natural lens with an artificial one, RLE can prevent the development of cataracts in the future.

Potential Risks and Complications

General risks of surgery

As with any surgical procedure, RLE comes with general risks such as infection, bleeding, or an adverse reaction to anesthesia. It is essential to follow your surgeon’s postoperative care instructions to minimize these risks and prevent infection afterwards.

Specific risks and complications associated with RLE

Although RLE is generally safe and effective, there are some specific risks and complications that may arise. These include temporary or permanent visual disturbances and blurred vision, such as glare, halos, or double vision.

In rare cases, retinal detachment or dislocation of the intraocular lens may occur. It is important to discuss these risks with eye surgeon and your ophthalmologist prior to the procedure.

Importance of choosing an Experienced Surgeon

Selecting a skilled and experienced surgeon is crucial to minimize risks and ensure the best possible outcome. When choosing a surgeon, consider their qualifications, years of experience, and patient testimonials. Do not hesitate to ask questions or request additional information about their success rates and complication rates with RLE.

Costs and Insurance Coverage

Average costs of RLE

The cost of RLE can vary widely depending on several factors, including the type of intraocular lens implant being used, the surgeon’s fees, and the geographic location of the clinic. On average, patients can expect to pay between $3,000 and $5,000 per eye for the procedure.

Factors influencing the cost

Factors that may influence the cost of RLE include the technology used during the surgery, the expertise of the surgeon, and the level of postoperative care provided. It is essential to consider these factors when comparing the costs of different clinics and surgeons.

Insurance coverage and financing options

Insurance coverage for RLE is not always guaranteed, as some companies may consider it an elective or costly procedure. However, if the surgery is deemed medically necessary (e.g., due to the presence of cataracts), insurance may cover a portion of the cost of eye procedure.

Be sure to check with your insurance provider to determine the extent of your coverage. Additionally, many clinics offer financing options and payment plans to help patients manage the cost of the surgery.

Patient financing is available online with Medicart


Refractive lens exchange is an effective vision correction option that involves replacing the natural lens of the eye with an artificial intraocular lens. It is particularly beneficial for individuals who may not be candidates for corneal-based procedures, such as LASIK or PRK. RLE offers numerous benefits, including improved vision, long-term stability of results, and prevention of cataract development. However, it is essential to be aware of the potential risks, complications, and costs associated with the re clear lens exchange procedure.

Ultimately, the decision to undergo refractive or contact lens exchange should be made in consultation with an experienced ophthalmologist who can provide personalized advice based on your eye health and unique laser vision correction needs. By seeking professional guidance, you your eye doctor can ensure that you make the best choice for your vision correction journey.

Refractive Lens Exchange (RLE) FAQ

Q: What is Refractive Lens Exchange?

A: Refractive Lens Exchange (RLE) is a surgical procedure that replaces your eye’s clear natural lens with an artificial intraocular lens (IOL). The lens changes the eye’s focusing power, thus inserting an artificial lens corrects refractive error, including both nearsightedness and farsightedness. RLE also provides the dual advantage of preventing the need for future cataract surgery, as an artificial lens is not susceptible to cataracts.

Q: How does RLE differ from Cataract Surgery?

A: Both RLE and cataract surgery, replace the eye’s natural lens, with a permanent man-made one instead. The difference is that RLE is an elective procedure, simply decreasing the need for glasses, while removing a formed cataract is medically necessary, as adequate vision cannot be achieved otherwise.

Q: Who is a candidate for RLE?

A: You may be a candidate for RLE surgery if you:

  • are forty-five or older with farsighted vision.
  • do not qualify as a candidate for laser eye surgery, due to acute nearsightedness or farsightedness.
  • wear bifocals or progressives lenses for both reading and distance vision.

Q: What complications may occur with RLE?

A: One percent of patients experience postoperative complications. Despite efforts to avoid such complications, the following may occur:

  • Eye infection (1 in 10,000 cases), usually requires emergency surgery, additional antibiotics and may result in vision loss. Dr. Conlon has not had a case of an intraocular infection in over twenty years.
  • Posterior ocular swelling (1 in 500 cases), is usually resolved with antibiotic drops.
  • Failed removal of the crystalline lens after one operation (1 in 1,000 cases), thus necessitating a second operation.
  • Retinal detachment, occurs when the thin tissue at the back of the eye pulls away from its normal position (1 in 1,000 cases). Requires surgical retinal reattachment.

Q: What testing is required prior to RLE?

A: The Conlon Eye Institute carries out the following tests and measurements prior to surgery:

Computerized Topography images the cornea’s both sides, to determine the degree of corneal astigmatism and orientation, and thus reduce astigmatism. Forms of treatment include laser arcuate incisions, limbal relaxing incisions, and/or a toric implant.

The IOL Master 700 determines intraocular lens power. This device measures the front of the eye’s curvature and its length. This information is used to calculate the lens’ power.

Macular Optical Coherence Tomography (OCT) is used to examine the macula, prior to RLE, to confirm the macular health, and thus eliminating any contraindication for RLE.

Q: Will RLE surgery increase my chances of getting a cataract?

A: Cataracts are a clouding of the eye’s natural lens. As RLE surgery removes the natural lenses, RLE eliminates the possibility of cataract development.

Q: What are the different lenses?

A: Saskatchewan’s Medical Services Branch (MSB) does not cover RLE implants but they are available for private purchase. These include:

  • toric implant besides reducing spherical aberration and enhancing the quality of vision, also reduces astigmatism, making it the best choice for higher degree astigmatism patients. Astigmatism correction is actually built directly into a toric  implant and then rotated to a specific orientation in the eye.
  • multifocal implant can improve both distance and near vision without glasses. This type of implant may cause glare and/or halos but these symptoms tend to diminish with time.

Q: Does insurance pay for RLE?

A: RLE is an elective procedure, and thus is left uncovered by insurance. MSB will cover cataract surgery, so for those experiencing visual impairment due to cataract,the surgery will be covered, minus the costs of upgrades from monofocal lenses. RLE is more expensive than laser vision correction as it must be performed in an accredited non-hospital surgical center.

Q: What technology does Dr. Conlon use to perform RLE?

A: The Conlon Eye Institute uses only the latest technologies to ensure optimal patient outcomes are achieved. For RLE, the LenSX Femtosecond Laser, and the ORA with VerifEye+ Systems, are combined to produce such results:

LenSX Femtosecond Laser performs surgical maneuvers previously undertaken with hand-held surgical tools. This blade-free laser technology completes corneal incisions, anterior capsulotomy and lens fragmentation with a newfound level of precision, consistently ensuring the best refractive outcomes.

The ORA with VerifEye+ System predicts whether a chosen implant will optimize your refractive outcome. Using this information, Dr. Conlon can adjust the implant as needed. The ORA system guides Dr. Conlon during IOL placement, providing real-time micro-measurements mid-surgery, allowing Dr. Conlon to adjust accordingly.