Refractive Lens Replacement: Definition

The generic term Refractive Lens Exchange (RLE) is used for a collective range of ophthalmic surgical procedures all of which involve a small incision being made at the cornea edge to remove the natural lens and replace it with a lens made of plastic or a silicone intraocular lens (IOL) of a preselected power.

The term is also used to describe Clear Lens Exchange (CLE), Clear Lens Extraction (CLE), Refractive Lens Replacement (RLR) and Presbyopic Lens Exchange (PRELEX).

Patients Benefitting from RLE

The type of treatment which may be offered to patients will normally depend upon a number of factors including age, health, medical history, lifestyle and patient expectations, as well as the type and severity of the eye disorder.

Those patients who suffer from cataracts or other refractive disorders such as presbyopia (inability to focus), kerataconus (swollen cornea) or extreme hyperopia (farsightedness), and who may have been deemed unsuitable for laser-based refractive surgery treatments, e.g. LASEK, LASIK or PRK, would probably be offered RLE treatment.

RLE can also be used to treat myopia (nearsightedness), patients with dry eyes, thin corneas and other minor corneal defects. However, because of the higher risk of retinal detachment during clear lens extraction, those patients with severe myopia will only be offered RLE after all other refractive surgery options have been considered.

Astigmatism (an irregularly shaped cornea which causes light to focus on two separate points) can also be treated with RLE, although as with hyperopia and myopia, some additional laser eye surgery (LASIK, LASEK or PRK) may be required.

Comparative Treatments

Laser treatments, such as LASIK, LASEK or PRK, may also be offered to patients with eye disorders, although the best solution for the patient will normally be dependent upon a number of factors with the patient’s age being a major determinant as to whether RLE is suitable or not.

Certainly, there are some advantages in receiving RLE as opposed to laser eye surgery. In the case of patients who demonstrate extreme hyperopia, mild degree cataracts and presbyopia symptoms, RLE surgery would provide a permanent solution for their conditions. Whereas refractive laser eye surgery (LASIK, LASEK or PRK) would not address the long-term problem of cataracts and presbyopia which may continue to worsen with age and may require cataract surgery. However, when comparing treatment costs between RLE and laser eye surgery, patients should consider the significantly higher cost of RLE which can be almost twice as expensive.

Non-surgical options for presbyopia include reading glasses, bifocal or progressive eyeglass lenses and multi-focal contact lenses.

Treatment Costs

It is very difficult to give a definite and accurate cost of treatment for refractive lens replacement as there are a number variables which may affect the actual cost. These include the clinic location, the surgeon, the amount of correction required and the technique used, as well as the eye disorder itself.

These variables mean that patients may experience a wide range of prices from £500 to £5,000, although a typical price would be around £1,800 per eye.

Subject to status, it may be possible to pay by interest or to spread the cost of surgery over a 48 month period.

Risks and Possible Complications

Although Refractive Lens replacement surgery is a frequently performed procedure, as with any surgery, there is some degree of risk. But, with the risk of complications less than 0.1%, the procedure is considered to be quite safe. Possible complications that could occur are:

    – Eye infection; although very uncommon, severe infection could lead to vision loss.
    – Disturbed vision caused by bleeding at the back of the eye.
    – Detachment of the retina – usually repaired by lasers and surgery.
    – Post-operative pain – remedied by non-prescriptive medication.
    – Ptosis – sometimes referred to as droopy eyelid.
    – Ocular hypertension – a condition that leads to increased eye pressure and which usually subsides within a few days.
    – Cornea or retinal swelling – usually treated with eye drops or in rare cases by additional surgery.
    – Posterior Capsule Opacification (PCO) – a condition where a fine, hazy film develops on the back of the lens implant but can be removed by a simple laser procedure.

As Refractive Lens Replacement is more invasive than LASIK or PRK techniques, it comes with slightly more risk of complications. However, complications which may lead to loss of sight are rare, and most complications are successfully treated with medication or additional surgery.

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