Refractive Lens Exchange, or RLE for short, is a procedure performed to help reduce or eliminate the need for glasses. It’s most commonly performed for patients between the ages of 45 and 65, prior to the onset of visually significant cataracts, but after the onset of presbyopia, since it’s past the ideal time to undergo laser refractive surgery.
In my opinion, the ideal candidate for Refractive Lens Exchange depends on their glasses to see BOTH far and near. If someone can already see perfectly far away, and only needs glasses for near, you need to think twice before proceeding. Your near vision should improve significantly, but there’s a possibility that your far vision is of sightly less quality.
During Refractive Lens Exchange, the eyes natural lens is replaced with a lens implant. Lens implants are available with varying characteristics. Some provide maximum RANGE of vision, allowing a patient to see far, near & in between without glasses. Others provide maximum QUALITY vision, allowing the patient to see extremely well far away, day and night, but they are more likely to depend on reading glasses for near vision.
Vision without glasses can be very good with a Max Range lens implant, allowing a patient to be mostly or completely independent from glasses.
No lens implant is perfect however, and so patients with a maximum Range lens may notice imperfections in their vision, such as glare at night or ghosting or shadowing when reading fine print. This is because current max Range lens implants are simultaneously focusing far, intermediate, and near objects in your view. Over time, the majority of patients see very well because the brain adapts to the new visual system. We call this neuroadaptation. This process can take many months.
From the current Max range lens implants available in the United States, one of my favorites is the Clearview 3 Lens by Lenstec. This lens provides a broad range of vision, with a relatively favorable night time vision profile, allowing patients to even drive at night comfortably. Some patients may describe an asymmetric flare eminating from car headlights, but the majority of patients tell me that it’s subtle and over time they don’t seem to notice it. In my experience, this lens has a very high satisfaction rate. it provides the vision clarity of a multifocal lens, but a higher tolerability, similar to extended depth of focus lenses, or EDOF lens for short.
No lens is perfect, and not everyone is a candidate for the clearview. The company does not manufacture a toric version that neutralizes astigmatism, and there is a limited power range available, meaning that if someone has a very short or very long eyeball, it may not be available in their size. Also, the clearview is not ideal for patients with tiny pupils.
If a patient really wants to get the clearview but they have significant astigmatism, a second procedure would be needed to reduce their astigmatism in order for the patient to see well without glasses.
If you have any questions, feel free to leave them in the comment section below!
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If you have any questions, feel free to leave them in the comment section below!
