Refractive Lens Exchange (RLE) is precisely the same procedure that we use to remove a cataract. Small incision cataract microsurgery is the most commonly performed procedure in all of medicine with extremely consistent excellent outcomes. Refractive Lens Exchange mates this procedure (crystalline lens removal) with the use of carefully chosen (often multifocal) implants to provide excellent vision without glasses or contact lenses in patients in whom such surgery is preferable to laser vision correction. The combination of Refractive Lens Exchange with limbal relaxation represents a powerful and important tool for providing excellent vision for many individuals.

Refractive Lens Exchange (RLE), sometimes called a Clear Lens Extraction or Presbyopic Lens Exchange, is used to treat a wide range of nearsightedness and farsightedness. This procedure involves removing the eye's natural crystalline lens and replacing it with an artificial lens. The process is the anatomical equivalent of cataract surgery; however in cataract surgery the lens is clouded, whereas in RLE, the patient's crystalline lens is clear. RLE is a better alternative than other refractive procedures in certain patients with high degrees of nearsightedness or farsightedness. The main advantages are rapid visual rehabilitation, excellent optical quality, predictability of outcome, and long-term stability. The other major advantage is that Refractive Lens Exchange, by virtue of removing the natural crystalline lens, which is the structure which eventually becomes a cataract, prevents the need for subsequent cataract surgery in our older patients or those who already have the early signs of cataract formation.

Conversely, our patients who already have visually significant cataracts have the option of combining their medically necessary insurance reimbursed cataract removal with the use of refractive technology, namely multifocal implants such as ReZoom, ReStor, and Crystalens along with limbal relaxation, to provide levels of vision without glasses or contact lenses that rivals that resulting from LASIK.


How does this surgery work?
Refractive Lens Exchange (RLE) eliminates the ability for the natural lens to accommodate from distance to near vision and if both eyes are corrected for best distance vision, reading glasses will be required. Another option is implantation of a multifocal lens such as the ReStor, ReZoom or Crystalens.  These implants allow for less dependence of reading glasses and improved uncorrected near vision.  The technique for RLE involves removing the natural lens of the eye using an ultrasound technique called phacoemulsification and replacing it with an intraocular lens implant. Prior to the day of surgery, measurements and tests are performed to determine the refractive power of the implant.

What can I expect on the day of surgery?

The Refractive Lens Exchange is performed on an outpatient basis at Piedmont Eye Surgical Center, adjacent to Piedmont Better Vision. Only one eye is treated at a time, with at least one week between surgeries. Upon arrival for your surgery, you will be given topical eye drops to numb your eye during the procedure. There are no needles or injections around your eye; however, IV sedation is available for increased relaxation. The skin around your eye will be thoroughly cleansed, and sterile coverings will be placed around your eye to keep the surgical area sterile during the procedure. Under the operating microscope, the surgeon will create a small microscopic opening into the eye. The lens is gently broken up using the phacoemulsication device that allows removal of the pieces through the tiny opening. The intraocular lens is carefully inserted. This type of incision typically does not require stitches. If you have a significant amount of corneal astigmatism, your surgeon will correct this during the procedure with peripheral corneal relaxing incisions. The surgery lasts about 15 minutes. You will begin to see an almost immediate improvement in your vision, progressing over the first 24 hours. You will be monitored for approximately 20 minutes and given post-operative instructions. You will leave fully alert, but will need someone to drive you home.


Piedmont Better Vision