Eye Doctor Sinking Spring PA
Refractive Surgery Sinking Spring PA, Clear Lens Extraction

Refractive Lens Exchange

What is RLE? • Safety • The Procedure • Advantages • Lens Implant Options

Expectations • A note on presbyopia • Alternatives


What is Refractive Lens Exchange?

Refractive Lens Exchange is commonly referred to as clear lens extraction or presbyopic lens correcting intraocular surgery. RLE is an emerging type of refractive surgery very similar to cataract surgery. Like many other types of refractive surgery, including LASIK eye surgery, Refractive Lens Exchange corrects nearsightedness and farsightedness. The desired refractive result is achieved with the insertion of a lens implant known as an IOL. Refractive Lens Exchange is a great option for an ophthalmologist to utilize when vision problems extend beyond the limits of lasers. For example, if a patient is too nearsighted but also has a reading issue one of these new multifocal lenses may be a good option. Prior to the advent of the multifocal lens refractive surgeons often performed monovision LASIK or simply just corrected the myopic disorder and then the patient just required glasses for reading. This type of refractive surgery may also be useful if a patient has extremely thin corneas not capable of handling laser surgery. Several visual situations could lead your surgeon to choose refractive lens exchange as your best option for vision correction. As reading vision problems begin to set in for many people in their 40s and 50s this type of surgery starts to make a lot more sense. Due to the multifocal capabilities of these new lens implants you now see at both far and near distances. Since cataract surgery is on the horizon and your natural lens will be removed you may consider this option ahead of time.

Safety

Because Refractive Lens Exchange is a procedure using the same technique as cataract surgery the procedure is regarded as relatively safe and effective. Although AAO guidelines prohibit ophthalmologists from calling this surgery safe it is clear that millions of eyes have received intraocular lens implants during cataract surgery and have had successful outcomes. With the advent of the new multifocal IOL, patients experience excellent vision after surgery. The main difference between these two surgical types is that one is for cataract removal and the other is to correct for refractive error.

The Refractive Lens Exchange Procedure

Refractive Lens Exchange uses the same technique used in cataract surgery. This technique has been used for decades and is the best method for cataract removal and lens insertion. During the surgical procedure the patient is first prepped using a local anesthetic and drops. After the eye has been sterilized the surgeon will make a 2.5 to 3 millimeter incision in the eye. In order to see inside the eye our doctors perform this delicate surgery with a powerful magnifying microscope. A device known as the emulsifier is inserted to the eye and begins to remove the natural lens. Once all of the lens material has been evacuated a foldable intraocular lens is inserted in the same place as the old lens. Refractive lens exchange is performed on an outpatient basis and only one eye is treated at a time. After the surgery is complete you will be required to go home and rest for the remainder of the day. Most patients report rapid visual improvement immediately after surgery.

Advantages of Refractive Lens Exchange

  • Reduces the dependence on glasses and contact lenses
  • Rapid visual recovery
  • Excellent results without the using a laser
  • Eliminates the need for cataract surgery in the future

Premium Lens Implant Options

Prior to undergoing the refractive lens exchange procedure you will be given several choices for lens implant options. Our doctors will make a lens suggestion based on your specific visual needs. Each of the premium lens implant options have unique attributes that may or may not be beneficial. The Multifocal IOL lens implants are also commonly called premium lens implants and are typically used in refractive lens exchange cases.

AcrySof® ReSTOR® intraocular lens (IOL)

ReSTOR Lens is a premium artificial lens that can restore a full range of vision without complete dependence on glasses or contact lenses. The FDA clinical studies identified that 80% of patients receiving the ReSTOR Lens no longer require glasses for any activity. This is a truly revolutionary lens that is a good option for patients that do not like the concept of monovision and would like to have a chance of eliminating glasses. If you have been told you are not an ideal patient for LASIK, the restor intraocular lens might be the next best option. Individuals between the ages of 40 and 60 years of age are typically the best candidates for refractive lens exchange with the Restor lens. If you have both distance and reading issues or you require bifocals this might be a better complete vision solution than the much-respected LASIK eye surgery. Patients often think that they are LASIK patients but after understanding their complete visual picture it is easy to see that the restor provides a better option for independence from glasses.

How does the AcrySof® ReSTOR® intraocular lens (IOL) work?

Various activities require different types of focusing. Your eyes are constantly changing focus on objects based on distance and proximity. The ability of the eye to actually change focusing is called accommodation. As people get older the ability to accommodate changes and the ability to read becomes impaired. The end result is that patients require reading glasses and in some cases bifocals. The restor lens was specifically designed to correct this exact issue. The lens actually provides both good near vision and good distance vision. By utilizing the apodized diffractive the lens is capable of providing multifocal vision. Diffraction involves the bending or spreading of light to multiple focal points as it passes through the lens. On the AcrySof® ReSTOR® IOL, the center of the lens surface consists of an apodized diffractive optic. This means that the series of tiny steps in that center area work together to focus light for near vision.
Source: Alcon Technologies Inc.

The benefit for refractive lens exchange patients is a high level of spectacle freedom. Alcon has patented the application of apodization technology to an IOL, making the AcrySof ReSTOR lens the first and only apodized diffractive IOL.

During U.S. clinical trials, the results with ReSTOR were remarkable:

  • 80% of patients reported that after lens implant surgery with ReSTOR lenses, they no longer needed glasses or contact lenses to see clearly at all distances.
  • 94% said they could drive and read the paper without contacts or glasses.
  • Nearly 94% were so satisfied that they would have the procedure again.

The Eyeonics Crystalens™

This new lens has made its impact as one of the top three inserted premium intraocular lenses but is called an accommodative lens not a multifocal lens like the restor and rezoom lenses. Crystalens™ is a single focus lens, which works with your eyes own muscles to accommodate in order for patients to enjoy vision as they did as youngsters. Crystalens™ has the ability to “accommodate,” or change shape, allowing it to focus on both distant and near objects. The patented hinged design element enables the lens to actually move and accommodate to focus near, far and intermediate objects. If you are considering refractive lens exchange this lens might allow you to eliminate or reduce glasses from your lifestyle. Imagine being able to drive a golf ball and see it in the distance or imagine being able to just read the newspaper or see the alarm clock at night. This lens has the capability to deliver excellent vision at all ranges. If you would like to know more about the Crystalens™ or refractive lens exchange surgery please feel free to fill out one of our contact forms and one of our staff will contact you. Our practice will thoroughly diagnose your vision and then educate you on all available premium lens options prior to making a decision about surgery.

The Crystalens FDA data presented (497 patients):

  • 98.4% of the patients could read NYSE, Wall Street Journal, Newspaper
  • 100% of the patients could read their Email or computer screens.
  • 98.4% were 20/40 or better in the distance (most were 20/20 or 20/30)

The ReZoom™ IOL


ReZoom™ intraocular lens is a refractive multifocal IOL that provides quality vision at near, far and intermediate distances. The lens is typically used in cataract surgery or refractive lens exchange cases and provides vision that traditional monofocal intraocular lenses cannot attain. The ReZoom™ IOL has a unique multifocal design that enables distribution of light over five optical zones. If you are seeking to completely eliminate your need for glasses this might not be the best option but the data suggests many patients are happy after this lens has been inserted. Obviously results will vary from patient to patient depending on vision. Before determining that this is the best lens option for your specific visual situation please make sure to consult directly with one of our doctors or trained ophthalmic staff.

Clinical Data
In study results provided by company officials:

  • 93.3% of ReZoom patients reported independence from glasses for distance.
  • For intermediate, 91.4% of patients reported independence from glasses. Meanwhile, 66.7% of patients reported independence from glasses for near.
  • 93.0% of patients never or only occasionally wore glasses, according to the data.

The clinical trials for each lens were conducted in different ways, so results may not be directly comparable

Expectations

Your expectations for the surgical outcome needs to be realistic and discussed with your surgeon prior to surgery. Replacing your natural lens with an artificial lens requires a little getting used to. Many people will experience and adjustment period while your brain is learning to see up close and at a distance with the new lens. The adjustment period typically ranges from 6 to 12 weeks and is in some cases even longer. It is not uncommon for patients to experience glare and haloes around objects immediately after the surgery. Over the course of time these effects should begin to diminish.

A Note on Presbyopia
How does RLE deal with the issue of presbyopia?

Presbyopia

Presbyopia is the natural deterioration of a patient’s near vision. Presbyopia is part of the eyes natural aging process and happens to everyone when they are old enough. The process typically starts in someone’s early forties with simple reading vision problems. Presbyopic patients will require bifocal glasses or contact lenses in order to see at all distances. Presbyopia is often referred to as a final frontier in vision correction because it is difficult to completely treat. Many presbyopic patient’s think that laser vision correction is a good option but they are mistaken. By using an accommodative lens or a multifocal IOL with refractive lens exchange presbyopia can be reduced and even successfully eliminated in many cases. Your expectations for eliminating glasses will need to be discussed with your surgeon.

Alternative Surgical Options

With the recent advancements in ophthalmic and optics technology there are many options to correct myopia and hyperopia. Only your qualified ophthalmologist will understand which option is best for you. If you are myopic laser vision correction or LASIK eye surgery may be a better option. If you are mildly hyperopic the Nearvision CK might be a good option. Please feel free to visit the LASIK eye surgery page for more information.

Family Eye Care Specialists