Refractive Lens Exchange (RLE)
Cavanaugh Eye Center offers the refractive lens exchange (RLE) procedure as an excellent option to obtain best possible freedom from glasses or contacts
If you are seeking information specific to cataract surgery, please click here.
Refractive Lens Exchange is essentially cataract surgery, but exclusively for refractive purposes. Rather then remove the cloudy human lens as is the case in cataract surgery, in RLE, the clear natural lens of the eye is removed and replaced with an intraocular lens implant (IOL) that is usually made of either acrylic or silicone. The replacement IOL corrects most, if not all, of the patient’s myopia, hyperopia, astigmatism, and even presbyopia (difficulty reading for patients over 40 years old). Multi-Focus IOLs such as the ReSTOR, Tecnis, and Crystalens IOLs are the implants of choice for patients wanting the greatest freedom from glasses for a full range of vision.
In the past, patients who were not candidates for LASIK, had very few refractive surgery options. Now, RLE may be the best option for people with high refractive error, thin corneas, presbyopia, and/or early cataracts. Because RLE removes the natural lens, there is no possibility of developing a cataract in the future and the replacement artificial lens lasts a lifetime.
The RLE Procedure
RLE surgery is performed in an outpatient ambulatory surgery center dedicated to ophthalmic surgery with state of the art equipment and well-trained nurses. In most cases, your surgery can be done with topical anesthetic using a numbing gel. For certain patients and more difficult cases, a local block can be done that provides a deeper level of anesthesia. Both are safe and eliminate the risk associated with general anesthesia.
During RLE surgery, Dr. Cavanaugh will make a very small incision either manually or with a laser at the junction of the white and colored parts of the eye. This incision is so small it seals without sutures in 99% of cases. In addition, you do not need to stop blood thinners for cataract surgery because the small incision is done through the clear cornea where there are no blood vessels. A sophisticated ultrasound vacuum, phacoemulsification, is used to remove the clouded cataract from within its outer clear membrane sac, called the capsule.
An Intraocular Lens Implant (IOL) is inserted into the empty capsule thereby providing a clear focusing pathway for light. This implant is individually calculated to be as accurate as possible to your eye’s prescription by measuring the length of the eye and the corneal curvature. Nearsightedness and farsightedness can be corrected at the same time the human lens is removed which can significantly reduce or sometimes eliminate the need for distance glasses. Premium IOLs can even correct Presbyopia and allow for reading without glasses in many cases.
RLE Lens Implant Options
Recent technological advancements offer us wonderful choices of intraocular lens implants (IOLs), but the variety of options can sometimes be confusing and overwhelming. There is no need to worry, however, as Dr. Cavanaugh will recommend the best Lens Implant Package for you based on exam findings, discussion during the exam, and your completed “Vision Questionnaire.” There are three different categories of IOLs. Most patients choosing RLE proceed with a multi-focus (presbyopia correcting lens implant). A description and list of your implant choices can be found here.
When does my vision become normal?
After the surgery, you will notice an immediately improvement but your vision may be somewhat blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has not yet undergone RLE. This healing period may take several weeks. How long it will be before you can see normally depends on the vision in your other eye, the lens you choose, your refractive target, and your vision before surgery.
Is refractive lens exchange surgery done with a laser?
Cataract surgery can be performed manually or with a laser. Dr. Cavanaugh is experienced with both methods. To learn more about manual versus bladeless, laser-assisted cataract surgery, click here.
How do I know if I am a candidate for the refractive lens exchange procedure?
RLE may be the best option for people over 40 with high refractive error, thin corneas, presbyopia, and/or early cataracts who are not candidates for other refractive procedures such as LASIK.
Will I ever get cataracts after RLE?
Because RLE removes the natural lens, there is no possibility of developing a cataract in the future. However, about 50% of all people who have cataract surgery or RLE develop a lens capsule opacity (the thin tissue bag that holds the replacement lens becomes cloudy) and require a YAG laser capsulotomy as decribed in the previous FAQ.
Will RLE treat my astigmatism?
Astigmatism can be corrected by three different surgical methods: Limbal Relaxing Incisions (LRIs), Toric IOLs, and LASIK. Our doctors will help determine which method is best for you. Since astigmatism treatment is also an elective procedure, the fees associated with your refractive lens exchange procedure include astigmatism correction.
How long does the surgery take?
Just like cataract surgery, the RLE procedure takes about 10-15 minutes. You’ll need to plan to be at the surgery center for approximately 2 hours, however, to accommodate the pre-op preparation and post-op recovery period. Our Ambulatory Surgery Centers have convenient drop off and pick up areas close to the door but since you will be sedated and blurry postop, you will be required to have someone drive you home after the procedure.
Is the procedure painful?
Patients experience virtually no discomfort during refractive lens exchange. In most cases your surgery can be done with topical anesthetic using a numbing gel. After the procedure, you will have some mild to moderate irritation for the first few days
Will both eyes be treated at the same time?
No, only one eye will be treated at a time. The second eye can be treated approximately 1-2 weeks after the first eye has healed and stabilized.
Will I still have to wear glasses?
Our goal for RLE patients is to obtain as much freedom from glasses as possible but there are no absolute guarantees. Multi-Focus lenses are the implants of choice for patients choosing RLE with the goal of the greatest freedom from glasses for a full range of vision. After the procedure, most patients can see distance and near objects simultaneously quite well in both eyes without glasses at least 80% of the time. When glasses are needed, it is usually for very fine print or for times when the lighting is poor.
Does insurance pay for RLE surgery?
Since RLE surgery is an elective procedure, most insurance companies will not pay for RLE. However, your employer’s flexible spending or cafeteria plan may offer tax advantages for RLE. We can help you understand your options and what questions to ask your benefits administrator. In addition, Cavanaugh Eye Center offers several different payment options through Care Credit to help make RLE fit your budget.
What are risks and complications of the surgery?
Comparable to cataract surgery, RLE is a 10 to 15 minute outpatient procedure done under local anesthetic with success rates of 98% to 99%. No surgery is 100% risk free. The risks with both cataract surgery and RLE that can lead to permanent loss of vision are rare and typically have less than a 1% chance of occurring. The main risks to be aware of include: retinal detachment, bleeding or hemorrhage during surgery, intraocular infection (endophthalmitis) after surgery, corneal swelling (permanent), macular or retinal swelling (cystoid macular edema) or not obtaining the desired refractive target or visual outcome. This list is brief and incomplete so please refer to your surgical consent for the complete list.
May I be co-managed with my Optometrist?
You may have been referred by your Optometrist for surgical care at our practice and ambulatory surgery center. Dr. Cavanaugh performs the surgery but if you prefer, your local eye doctor can assume the postoperative care at the one-day, one-week or one-month juncture. Your local doctor communicates your post-operative results to Dr. Cavanaugh. If there are any concerns, Dr. Cavanaugh may ask to see you personally. Your local Eye Doctor is paid a portion of the global fee for surgery to compensate for the post-operative visits they do for you.
Where is the surgery done?
Dr. Cavanaugh operates in several excellent Ophthalmic Ambulatory Surgery Centers. Click here to link to our locations page for a full description.