Lens Replacement (RLE)

Lens replacement or Refractive Lens Exchange (RLE) is an advanced form of vision correction surgery which we use to treat patients over 50 years of age who need glasses for both distance and for reading.

With this treatment, up to 95% of patients are entirely glasses free with the remaining 5% of patients needing to wear a weak pair of glasses for specific tasks such as reading very tiny print or reading in the very dim light.

RLE is similar to cataract surgery in many ways, but there are significant differences. In both cataract surgery and RLE surgery, I remove the natural lens of the eye and permanently replace it with an artificial intraocular lens (IOL).

RLE differs in that it requires:

• more sophisticated pre-operative testing to measure the eye’s optics,
• more sophisticated lens implants such as multifocal and toric lens implant, and
• an experienced surgeon with very low complication rates.

Furthermore, you need a surgeon who is also experienced in laser eye surgery because up to 5% of patients who undergo refractive lens exchange require a minor laser eye surgery procedure to fine tune the vision and achieve the very best outcome.

The benefits of multifocal intraocular lenses are:

• They will correct both distance and reading vision
• No / minimal need for glasses

The compromises that are required when patients are considering this treatment:

• All patients experience glare and halos in the first few days to weeks after surgery and especially at night. These side-effects slowly fade away but may initially prevent safe driving at night.
• The period of adaptation can take anything between 1 week to 3 months. All patients will have a small number of residual halos around lights, but this is minor, and you’ll likely tolerate it.
• For best vision, patients must have virtually no residual glasses prescription following treatment. Up to 5% of patients require a minor laser eye surgery procedure to correct any remaining glasses prescription and achieve best results.
• While 95% of patients who have trifocal lens implants are entirely free of glasses, 5% of patients require occasional glasses use for specific tasks.
• With short-sighted patients this is typically glasses for prolonged computer work but not for reading.
• For long sighted patients this is typically a pair of weak reading glasses for reading in dim light or for reading tiny text.

If you are over 50 and have both distance glasses and are noticing symptoms of what we call presbyopia (difficulty reading close up without reading glasses), then RLE may provide you with an excellent solution.

Furthermore, many patients who never wore glasses in their life and who have worn reading glasses for several years find that eventually, they also start to develop deterioration in their distance vision.

This may be due to early cataract in short-sighted patients or to increasing long sightedness in other patients. If any of these sounds like you then refractive lens exchange may well be an excellent solution to give you glasses-free vision.

Multifocal lens implants are an advanced type of lens implant that is not available on the NHS. After RLE, the focused light from the distance, intermediate (computer/TV) and close up (reading) range fall onto the retina all at once. The human brain then learns to construct a three-dimensional world from all of this information. We can achieve the best results when a patient has multifocal lenses in both eyes.

The three leading types of multifocal lenses are:

• Extended Depth of focus intraocular lenses
• Trifocal intraocular lenses
• Rotationally asymmetric intraocular lenses.

All of these lenses come in standard and in astigmatism correcting toric forms.

The steps involved in RLE and Lens Replacement are the same as those we take in cataract surgery.

RLE is an excellent treatment for patients who need a variety of different pairs of glasses for distance, intermediate and reading. It’s also suitable for patients who have early cataract and who want to be free of glasses.

It is necessary, however, that patients understand that no treatment can restore the same vision they had at age 18. If, however, they are willing to tolerate some minor compromises, RLE offers a 95% chance of being wholly spectacle-free. This procedure provides the added benefit that you’ll avoid any future cataract.