Refractive Lens Exchange

Refractive Lens Exchange

An intraocular lens implant placed permanently in the eye once the natural lens has been removed helps reduce or eliminate the need for glasses or contact lenses after refractive lensectomy.

Refractive lens exchange is a procedure designed to reduce a person’s dependence on glasses or contact lenses. The eye has a lens that works much like the lens of a camera to keep things in focus.

Sometimes, the power of that natural, human lens is not correct for the eye. The result is blurred vision from either nearsightedness, or farsightedness or astigmatism.

Refractive lens exchange can correct these vision disorders by replacing the eye's natural lens with an artifical plastic lens known as an intra-ocular lens implant. The power of the artificial lens that will work best is determined by painless in-office measurements done before the procedure.

The latest advance in refractive lens exchange surgery is the use of bifocal-like intraocular lens implants called “multifocal implants” which not only reduce or eliminate the need for glasses to see far away, but which also make it possible to read and see up-close with little or no need for glasses.

The tip of a pencil-sized instrument painlessly vacuums the clear lens out of the eye through a tiny incision after breaking it into fragments with ultrasound.

The refractive lens exchange procedure is painless. It usually takes about 20 minutes and is performed under a local or topical anesthetic in an outpatient surgery center. Once the eye is numb, a tiny opening about the size of pencil tip is made in the cornea, or clear front window of the eye. The tip of a pencil-shaped instrument is then placed through the incision and emits sound waves (ultrasound) to break the natural lens into tiny fragments. This same instrument then vacuums out the fragments.

Next, an appropriately-powered plastic 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 incision is so small that it generally requires no stitches. You are on your feet the same day, back to almost all of your normal activities the next day, and usually seeing very well – with little or no need for glasses—within a day or two.

The same surgical technique is used to remove cataracts, usually in people over the age of 65. A cataract is a cloudy lens that prevents a person from seeing well even with his or her best pair of glasses. Cataracts usually occur as a normal part of aging. Refractive lens exchange involves removing one’s natural lens while it is still clear, and not yet cloudy. While cloudy vision is the main indication for cataract surgery, a desire to decrease or eliminate the need for glasses or contact lenses is the main indication for refractive lens exchange.

Clear lens removed in
refractive lens exchange

Yellowed, cloudy lens removed in cataract surgery

Refractive lens exchange is most often recommended when a patient is not a good candidate for laser vision correction procedures to reduce or eliminate the need for glasses or contacts. They may have a need for correction that is beyond the range of laser vision correction, corneas that are too thin for laser vision correction, or an eye condition that makes laser vision correction unsafe or unwise.

Refractive lens exchange is not generally recommended for people under 45 years of age, although there can be exceptions. It is not covered by insurance, unless one’s natural lens is affected by a significant cataract. And, as with any surgery, complications are possible. However, it is generally considered to be quite safe and quite effective for patients who are appropriate candidates.

At the time of your visit, we will determine whether or not you are a
good candidate for this procedure, and will explain it in more detail.