Refractive Lens Exchange


Our world is filled with an extreme variety of colors, shapes, and patterns. Eyes give us the ability to perceive movement, and give us the ability to make assessments about that movement. Our eyes are important because they bring beauty and understanding of the world to us. Any problem in viewing the world clearly or any discomfort in our eyes can be a sign of an eye disease. Thus, regular eye tests must be done to ensure a good health of our eyes. At Aakash,stringent assurance and quality checks ensure reliable and high quality test results. Aakash Hospital is known to provide adept and modern medical services. The ophthalmology department at Aakash, is equipped with the latest technology and state-of-the-art equipment to offer world class diagnosis and treatment for different eye diseases.

Refractive Lens Exchange (RLE), also called Clear Lens Exchange (CLE), is a procedure with twofold benefits for the aging eye. During the surgery, the eye’s natural crystalline lens is replaced with an artificial lens. This artificial lens corrects any existing nearsightedness, farsightedness, and astigmatism, and also eliminates the patient’s inevitable future development of cataracts in the crystalline lens.

Refractive lens exchange (RLE) replaces your eye's clear natural lens with an artificial intraocular lens (IOL) to correct your focusing error and achieve sharper focus, reducing your need for reading glasses or bifocals/graduated lenses.

The procedure for refractive lens exchange is virtually identical to cataract surgery. The difference is that in RLE, the lens being replaced is clear, rather than a cloudy lens due to a cataract.

There are different types of IOL’s available to replace your natural lens, depending on your vision needs and the health of your eyes.They are:

  • Monofocal fixed-focus IOLs: Monofocal lenses provide clear vision at distance, intermediate or near ranges — but not all three at once. Toric IOLs to correct astigmatism also are classified as monofocal IOLs.
  • Multifocal IOLs: A multifocal lens provides clear vision at multiple distances.
  • Accommodating IOLs: An accommodating IOL is a type of monofocal lens that enables focus at multiple distances by shifting its position in the eye.
  • EDOF (Extended Depth Of Focus) IOL: These IOL’s spread focused light over a greater distance allowing patients to have a more continuous range of vision without the possibility of “gaps” in the vision. They are also less likely to induce night vision haloes or starburst effects than Multifocal IOL’s.

With intraocular lenses, there is no "one size fits all," and your eye surgeon will recommend an IOL that is most suitable for your individual needs.

What is the procedure of this surgery?

Lens replacement surgery usually takes about 20 minutes and is performed on an outpatient basis. Each eye is done separately, usually about a week apart. Numbing anaesthetic drops are used during the procedure, so typically there is no discomfort, and most people report immediate vision improvement after surgery.

Initial recovery from refractive lens exchange — when you can resume normal everyday activities — usually takes about a week. Final outcomes of refractive lens exchange can take up to several weeks, and you may notice vision disturbances such as blurry vision, halos and glare, or a "scratchy" sensation as your eyes heal. You should be able to return to work and resume driving within a week of surgery, dependent on your eye surgeon's instructions.

The artificial intraocular lens is a permanent replacement for your natural lens and is designed to last the rest of your life. And, because IOL’s are not affected by age-related changes, there is minimal risk of regression (loss of corrective effect or deterioration of vision) over time.

What are the risks?

In all forms of eye surgery, problems can occur during the operation or afterwards in the healing period. Problems can result in permanent, serious loss of vision (vision worse than the driving standard in the affected eye that cannot be corrected with spectacles or contact lenses). More commonly, problems can be corrected with changes in medication or additional surgery. Typically, these additional operations feel like the original surgery and have a similar recovery period.

Loss of vision

Permanent, serious loss of vision is significantly more common after RLE than after laser vision correction or PIOL implantation, affecting approximately one in 500 patients. In the worst scenario, complete loss of vision may occur in the affected eye.

Permanent serious visual loss is typically caused by damage to the retina. This can result from infection or an inflammatory response after surgery, retinal detachment after surgery, or bleeding during surgery. Some problems occurring during surgery increase the risk of sight threatening problems afterwards. These include a common complication of surgery called posterior capsular rupture, (breakage of the membrane just behind the IOL).

Additional surgery

Second operations may be required to correct a complication from the initial surgery. This could include lens repositioning or exchange, surgery to retrieve lens fragments from the back of the eye, or retinal detachment repair. With or without RLE, retinal detachments are more common if you are very short-sighted; but the risk of retinal detachment is approximately five times higher in the first four years after cataract surgery or refractive lens exchange.

Statistical techniques (biometry formulae) and eye measurements (biometry) are used to guide selection of the IOL required to correct your vision. Limitations on the accuracy of these techniques mean that laser vision correction to fine tune the focus is often required to touch up the visual result after RLE.

The commonest reason for visual deterioration after RLE is posterior capsule opacification (PCO). This is a gradual misting over of the membrane just behind the IOL, which affects many patients. PCO may occur months or years after surgery, and is normally treated successfully with a one-off minor laser procedure called YAG laser capsulotomy.

Risks of contact lens wear

Continuing in contact lenses is often the main alternative for people considering sight correction surgery. If you follow the right safety advice, contact lens wear is low risk; but approximately one in 3000 wearers each year will develop a serious corneal infection.To minimize this risk, you should not swim or shower in contact lenses, and should not wash them in tap water. Sleeping in contact lenses, including those designed for overnight wear, increases the risk of infection significantly. Soft, daily disposable lenses are safer than non-disposable lenses.


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