With intraocular lenses, there is no “one size fits all,” and your eye surgeon will recommend an IOL that is most suitable for your individual needs.
Refractive lens exchange, also called lens replacement surgery or clear lens extraction, may be a better option than LASIK or PRK for people with presbyopia and high hyperopia (farsightedness).
Refractive lens exchange (RLE) replaces your eye’s clear natural lens with an artificial intraocular lens (IOL) to correct your refractive error and achieve sharper focus, reducing your need for reading glasses or bifocals.
The procedure for refractive lens exchange is virtually identical to cataract surgery. The difference is that in RLE, the lens being replaced is clear, rather than a cloudy lens due to a cataract.
Multifocal Surgery is one type of IOL. It provides sight on three distances at the same time, due to its “multifocality”- e.g. zones in the lens.
Lens replacement surgery usually takes about 10-15 minutes per eye and is performed on an outpatient basis. Each eye is done separately but mostly at the same day.
Anesthetic drops are used during RLE, so typically there is no discomfort, and most people report immediate vision improvement after surgery. Recovery time can take up to several months before fully adjusting to your new vision.
Hyperopia, presbyopia, ineligibility for LASIK or phakic IOL ( ICL )
Procedure time: about 10-15 minutes per eye
Typical results: clear vision at all distances without glasses or contact lenses
Recovery time: a few days to several weeks.
Initial recovery from refractive lens exchange – when you can resume normal everyday activities – usually takes about a week. Final outcomes of refractive lens exchange can take up to several weeks, and you may notice vision disturbances such as blurry vision, halos and glare, or a “scratchy” sensation as your eyes heal. You should be able to return to work and resume driving within a week of surgery, dependent on your eye surgeon’s instructions.
Normally, you won’t feel an IOL in your eye, since the lens implant is inside your eye and not on the surface like a contact lens, it’s not visible to others.
The artificial intraocular lens is a permanent replacement for your natural lens and is designed to last the rest of your life. Also, there is minimal risk of regression (loss of corrective effect or deterioration of vision) over time.
Refractive Lens Exchange vs. LASIK
While LASIK remains the most popular option for correcting myopia and hyperopia, if you have a very severe refractive error or an abnormal cornea, lens-based refractive surgery such as clear lens extraction or phakic IOL ( ICL ) implantation may be a better alternative.
Unlike LASIK or PRK, refractive lens exchange can correct almost any degree of hyperopia, and visual acuity after RLE surgery often is better than LASIK and PRK outcomes in cases of moderate and high hyperopia.
If you have myopia, RLE usually is performed only if you are not a suitable candidate for any other vision correction surgery. People with myopia have a higher risk of retinal detachment after clear lens extraction, and other refractive surgery options should be explored first.
Vision After Refractive Lens Exchange
Whether you will need eyeglasses or contact lenses after refractive lens exchange depends on the type of intraocular lens used.
Multifocal IOLs have been used extensively in cataract surgery and clear lens exchange. They offer excellent vision and contrast sensitivity and have low instances of vision disturbances such as halos and glare.
However, because multifocals are designed to focus only at one distance, you will likely need glasses for up-close tasks such as reading fine print and working at a computer.