Refractive lens exchange (RLE) is a permanent, maintenance-free vision correction option for nearsightedness, farsightedness, astigmatism and even presbyopia. During the RLE procedure, your eyes’ natural lenses are replaced with artificial lens called intraocular implant lens (IOL) to reduce your dependence on glasses or contact lenses.

RLE is identical to cataract surgery, only it’s performed before cataracts have developed, and prevents them from developing. The procedure takes approximately 15- 20 minutes per eye and touts a short recovery time.

The best candidates for refractive lens exchange are individuals with high nearsightedness, moderate to high farsightedness, and those with farsightedness and presbyopia, the gradual loss of your eyes’ ability to focus on nearby objects. These conditions are called “refractive errors.”

Nearsightedness (Myopia): The eye is too long or the cornea is too steeply curved. Light passes through the eye but focuses before it reaches the retina, which causes distant objects to appear blurry.

Farsightedness (Hyperopia): The eye is too short or the cornea is relatively flat. Before light has covered enough distance to focus, it reaches the retina, which causes images that are close at hand to be blurred. Depending on age and the eye’s ability to accommodate, distant objects usually appear blurry as well.

Astigmatism: The cornea is oval-shaped like a football. When light passes through the cornea, it focuses in more than one place relative to the retina, which causes images near or far to appear blurred and distorted.

Emmetropia: the absence of a refractive error, and the ultimate goal of RLE.

Before the RLE procedure, you and your doctor will discuss lens types to determine which one best fits your needs and conditions.

Monofocal: Corrects nearsightedness and farsightedness (but not astigmatism or presbyopia), and provides excellent vision at one point of focus, usually distance. This lens can be used to provide “monovision” or “blended vision,” where one eye is corrected for distance, and the other eye is corrected for either intermediate or near vision.

Toric IOL: Corrects higher amounts of astigmatism using a special IOL to provide clear distance vision, near vision or both, depending on the desired result.

Limbal Relaxing Incisions: At the same time the RLE is performed, an incision is made either by hand or with a laser in the outer margins of the cornea to improve vision for individuals with mild amounts of astigmatism. These micro-incisions, called limbal relaxing incisions (LRI), create a more symmetrical cornea, which can reduce or eliminate astigmatism.

Multifocal IOL (also known as presbyopia-correcting IOL): Provide a full range of clearer vision at multiple distances – near, distant and intermediate. This allows you to perform most of your daily activities with reduced or no dependence on glasses. The PanOptix Trifolcal Lens is an example of a multifocal IOL.

RLE is usually done as an outpatient procedure under a local or topical anesthetic. Only one eye is treated per procedure. Once the eye is numb, a microscopic opening about the size of a pencil tip is made in the cornea (clear front window of the eye). The tip of an instrument shaped like a pencil is then placed through the incision, emitting sound waves (ultrasound) to break the natural lens into tiny fragments that are vacuumed out of the eye. The entire procedure takes only 15-20 minutes. Next, the lens implant is folded up like a taco and inserted through the same small incision. The lens implant unfolds inside the eye and remains there permanently. The tiny incision is self-healing, which means no sutures are required.

After the procedure, you’re able to go home to rest for the day. Although everyone heals differently, many patients report their vision improves soon after the procedure, and you can return to normal activities within 7-10 days. RLE is usually performed on the second eye within a couple weeks.