Refractive Lens Procedure

What is Refractive Lens Exchange?

Refractive Lens Exchange (RLE), also called Clear Lens Extraction, is a procedure that involves replacing the eye’s natural lens with an Intraocular Lens (IOL) as an alternative to laser vision correction. It can correct pre-existing nearsightedness, farsightedness, astigmatism, and presbyopia. Presbyopia is a progressive condition typically requiring individuals over the age of 40 to become dependent on glasses for near vision.

In the past ten years, more than 3 million eyes per year in the United States have received an IOL when undergoing cataract surgery, which uses the same highly successful surgical techniques used in RLE. RLE may be the procedure of choice for patients who are too nearsighted, too farsighted or have corneas that are too thin for laser vision correction.  It may also be a viable option for those over the age of 40 who wish to eliminate their dependence on bifocals or reading glasses and for those individuals who may be showing early signs of developing cataracts.

There are three anatomical factors that contribute to how well the eye can focus:  the curvature of the cornea, the power of the eye’s internal natural lens, and the length of the eye.  Vision correction procedures such as LASIK, SMILE, or Advanced Surface Ablation change the focusing power of the eye by changing the curvature of the cornea. RLE, on the other hand, changes the focusing power of the eye with an intraocular lens of the appropriate power which is determined by the length of the eye and its corneal curvature.

 

Advanced Technology IOLs

Exciting advances in intraocular lens design allow Clear Choice patients the opportunity to maximize their visual outcome. The Clear Choice surgeons offer patients the most advanced lens implant technology.

The options explained in this brochure are the Panoptix Trifocal Lens Implant, and the Light Adjustable Lens Implant for distance or for monovision. (Monovision is a vision strategy where one eye is corrected for optimal distance vision, and the other eye is corrected for optimal reading vision.). These are two of the most common intraocular lens options offered by the Clear Choice surgeons. These are not the only lens options that the Clear Choice surgeons have experience with. The surgeons have access to a myriad of lens implants, and they will recommend the technology that they feel will best meet your vision needs.

 

The Panoptix Trifocal Lens Implant

The Panoptix Trifocal Lens Implant can provide a full range of clearer vision at multiple distances; near, intermediate, and distant, allowing a person to perform most of their daily activities with reduced dependence, or no dependence, on glasses or contact lenses. The Panoptix Trifocal Lens Implant is implanted using the same standard surgical techniques for conventional cataract surgery.

A trifocal lens implant works by bending the light entering the eye from near, intermediate, and far distances, and focusing this light onto a single focal point on your retina.  This enables you to focus on objects at different distances simultaneously, providing near, intermediate, and distant vision. The Panoptix Trifocal lens can be used for patients who are nearsighted, farsighted, and for those with astigmatism as well.

 

The Personalized Light Adjustable Lens Implant (LAL)

The Personalized Light Adjustable Lens (LAL) is a unique lens that can be customized for a monovision outcome, or for maximum distance vision in both eyes. The Light Adjustable Lens is implanted using the same standard surgical techniques for conventional cataract surgery.  After the eye has healed, the patient comes in for a routine vision exam.  The surgeon can then customize the lens power by directing a low-intensity beam of UV light onto the lens from outside the eye. The light is delivered via a device used in the office called a Light Delivery Device (LDD) and the special photosensitive material of the lens reacts to the UV light and changes shape to match the prescription the patient selected during their eye exam.  Patients who choose the LAL will need to protect their eyes from UV light for about 6 weeks post-op with special glasses.

A patient who chooses the LAL as their solution for vision can choose to have both eyes corrected for maximum distance vision, or for monovision. If the patient opts to have both eyes corrected for distance vision, he or she will wear reading glasses for up-close vision.

If a LAL patient chooses monovision, the surgeon will correct one eye for distance vision, and the other eye for reading vision. Many patients who select a monovision strategy will find that a light prescription pair of glasses will help with better night driving vision.

 

Correcting Astigmatism

Astigmatism is often present along with nearsightedness and farsightedness. It occurs when the cornea is shaped like a football, more curved in one direction than the other. This causes images to focus at multiple points on the retina, thereby creating blurry vision at all distances.  Both the Panoptic Trifocal Lens Implant and the Personalized Light Adjustable Lens Implant correct astigmatism.

 

The Procedure

Refractive Lens Exchange is performed at Brecksville Surgery Center, located in suite A of our building.  Your pre and post-operative appointments will be performed either at Clear Choice Custom LASIK Center, at Cleveland Eye Clinic or at your optometrist’s office.

Clear Choice patients receive anesthesia to ensure their comfort during the procedure. Your eye will be numbed as well. The Clear Choice surgeons offer intravenous anesthesia and oral anesthesia for those who don’t prefer needles. Today’s modern surgical techniques allow surgeons to remove the natural lens from the eye using ultrasonic vibrations through a microincision of 3mm or less. The natural lens is replaced by the intraocular lens, which is inserted through the microincision. Once inside the eye, the lens automatically unfolds as it is placed into its position.

Patients go home soon after the procedure to relax for the rest of the day. Everyone heals somewhat differently but many patients report improvement in their vision almost immediately, and most resume their normal activities within a day or two. In many instances, the surgeon will give the patient the option of having both eyes done on the same day.  But in some instances, the surgeon may recommend having the eyes done a week or so apart. Your vision will continue to improve over time as your brain adapts to your new intraocular lenses.  Once stable, your vision is unlikely to change over time. Patients having RLE will avoid the need for cataract surgery later in life.

 

RLE Considerations

Patients having RLE have minimal risks of experiencing side effects and complications. RLE involves surgery inside the eye, there are a number of side effects and complications associated with RLE. You will be given additional information about these risks that will help you decide if RLE is right for you. You will have an opportunity to speak to your doctor about these risks.

 

YAG Capsulotomy Laser Treatment

During RLE, the natural lens inside your eye gets replaced by a man-made lens. The new man-made lens is put inside the lens membrane (called the bag or capsule) in your eye. In a small number of patients, the capsule thickens after surgery and becomes cloudy. This interferes with light reaching the back of the eye. When this happens, your sight may become misty, and you may get glare from bright light or from lights at nighttime.

A YAG Capsulotomy laser treatment is used to remove the cloudy capsule thickening in your eye, which aims to restore your vision to how it was after your RLE procedure. In a YAG laser capsulotomy, the doctor uses a special lens to apply a laser beam to the capsule. This creates a small hole in the center of the capsule, which lets light through.

The YAG laser capsulotomy is a walk-in/walk-out procedure. You can drive to and from the appointment. It is quick and painless. The YAG capsulotomy procedure is covered by medical insurance.

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