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Learn about Refractive Lens Exchange (RLE)

Refractive Lens Exchange There are many surgeries that can help improve your vision including LASIK, PRK, CK, LASEK and more. Read on to learn more about one option, called "Refractive Lens Exchange," and find out if this surgery may be right for you.

What is Refractive Lens Exchange?
Refractive Lens Exchange, also called Clear Lens Extraction (CLE), Clear Lens Exchange (CLE) or Refractive Lens Replacement (RLR), is basically cataract surgery done for refractive purposes.

During RLE, the eye's natural lens is removed and replaced with an artificial one, called an intraocular lens. In the past, this meant that the patient would only be able to see clearly at a particular distance (near, intermediate, or far), because the only artificial lenses available were monofocal. They could not accommodate like the natural lens, which changes shape to focus at different distances. If the replacement lens allowed for good distance vision, the patient would need glasses or contact lenses for near work (like reading), and vice versa.

Modern intraocular lenses can be "multifocal" or "accomodating," meaning they allow the patient to see clearly at multiple distances, just like the eye's natural lens. Accomodating intraocular lenses include AcrySof ReStor (Alcon), ReZoom (Advanced Medical Optics), Crystalens (Bausch & Lomb), and Synchrony (Visiogen Inc.).

Who is a good candidate for the surgery?
The U.S. FDA has not approved lens replacement surgery for refractive purposes, but some surgeons will perform RLE "off-label" in certain circumstances. This is completely legal and a good option for some patients.

If you need vision correction but are already beginning to develop cataracts, RLE may be a better option than a laser method like LASIK. RLE is also a good option for patients ineligible for laser surgery, such as those with thin corneas, dry eyes, or a very high refractive error.

Advantages and Disadvantages of RLE
One advantage of RLE is that the cornea mostly remains untouched, making the surgery a good option for those with corneal problems.

RLE is also great choice for patients with cataracts, since their natural lenses will need to be replaced eventually anyway. Why wait for the disease to progress when you could see clearly now? It is not possible to get cataracts after RLE.

A major disadvantage is that RLE is considered elective, and is probably not covered by your insurance. Surgery can cost $2,500 - $4,500 per eye or more. RLE is also more invasive than corneal-based refractive surgery.

Even with multifocal lenses, the patient will not have the same range of accommodation they had before surgery, and will probably require glasses or contacts for some activities.

RLE, like any surgery, comes with possible side effects and complications. It also may increase your risk of certain conditions, such as retinal detachment.

Finding a surgeon
If you are interested in RLE, look for a good cataract surgeon. Many refractive surgeons work exclusively within the cornea, and not only will not perform RLE, but may not even mention it as an option.

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