Refractive Lens Exchange: Top 10 Questions Answered

1. What is Refractive Lens Exchange surgery?

Refractive lens exchange (RLE) is effectively like doing cataract surgery but doing it early without the presence of a cataract. The aim of the lens exchange treatment is to reduce dependence on glasses. The natural lens is removed and a new customized lens is put in its place which corrects the spectacle prescription.

This is now a popular procedure for those not suitable for laser eye surgery. By performing refractive lens exchange surgery, you would not develop a cataract in later life as the lens has already been removed.

2. What types of lenses are used in refractive lens exchange surgery?

Each patient and each eye is different so we take measurements before surgery (called biometry) to establish the correct lens power for each individual eye. The lens implants we use come in different types and we help you navigate through the options to make sure you have the best lenses to suit your needs.

The two main categories of lens implant are:

• Monofocal lenses

These provide good distance vision or good near vision but not both. In some cases, we can use a distance lens in one eye and a near lens in the non-dominant eye which is called blended or mono-vision. This is suitable for some but not all patients.

• Multifocal lenses

These lenses offer a high probability of achieving spectacle independence i.e. providing you with the ability to see far as well as to read without glasses. With multifocal lenses, each eye sees far and near and the eyes work together for both distance and near vision.

Trifocal lenses which allow you to see far, intermediate and near via three distinct focal points in the lens fall into the multifocal lens category and are the most popular lenses on the market at present.

Find out more about lens choices for refractive lens exchange.

3. How long does the procedure take and can you treat both eyes on the same day?

The procedure takes 15-20 minutes per eye. Due to improvements in safety elite refractive surgeons are now able to treat both eyes on the same day in most patients. Otherwise, the worst eye is treated first and the other eye treated subsequently. In the majority of cases, we perform the procedure under local anaesthetic drops so the recovery is fast. However, we can offer you sedation or a full general anaesthetic if you are especially nervous. This will be discussed and decided with you at your consultation with our specialist team and one of our lead surgeons.

4. Will my healthcare insurance cover the cost of lens exchange surgery?

Typically insurance companies cover the cost of cataract surgery but not refractive lens exchange surgery as this is deemed a cosmetic procedure. If you have a cataract they should cover the cost of the cataract surgery but there would be an excess to pay to cover the cost of multi focal lenses as insurance companies don’t cover these lens types. We always advise you to speak to your insurance provider to make sure you know what is and isn’t covered.

5. How much does refractive lens exchange surgery cost?

We have developed package prices for all of our procedures so you only pay one bill which includes the surgery, hospital fees, cost of lenses and all your follow up care so you can be sure of what you’re paying. Please see our costs page.

6. What happens at the initial consultation?

You should expect to be with us for approximately 1.5 hours for your consultation as we perform a detailed assessment of your eyes.

• A technician will carry out various specialist diagnostic tests on your eyes.
• You will then be seen by one of our specially trained optometrists who will test your vision and do a further detailed examination of your eyes.
• You will then see our clinical lead Mr. Ali Mearza who will be the surgeon performing your surgery. He will examine your eyes and the test results and discuss treatment and lens options with you to ensure that you go away with a personalized  plan meets your specific needs.
• You can then book a surgery appointment and we will send you an information pack with details of the surgery, a consent form and information on what to expect after the surgery. You will also be given information about our free eye drops app to download so that you are sent notifications to remind you to take your eye drops after surgery.

7. Am I awake during the surgery?

Our surgeons perform most cases using anaesthetic eye drops, so you are awake throughout the procedure. However, you can also request a tablet (diazepam) to take on the day of the procedure to make sure you are as comfortable and relaxed as possible. In certain circumstances some people may prefer a general anaesthetic or sedation which will all be discussed at the initial consultation and assessment. The main thing is that you are happy with the plan and have all the options available to you so you can make a choice.

8. What happens on the surgery day?

You will be at the clinic for 2 – 2.5 hours on the day of your surgery. The reception team will show you to the ward area where you will meet the nurses that will be looking after you that day.

The nurses will use some drops to dilate your pupil(s) and discuss the aftercare with you.

We will take the signed consent forms from you and then you will see your surgeon again to talk through the treatment and answer any final questions you have. He will make sure you are as comfortable and relaxed as possible prior to the procedure.

The refractive lens exchange surgery then takes approximately 15 – 20 minutes (per eye).

You will then rest in the recovery suite for 30 – 45 minutes.

Your surgeon will check all is well before you are discharged home.

It is best to go home with sunglasses on to protect your eyes and keep them as comfortable as possible. You will have been given eye shields to wear at night for the first night after surgery as well your aftercare eye drops.

Your eyes will feel tired and gritty for the rest of the day so we advise that you go home and rest.

You should be able to return to work within 24-48 hours.

Your surgeon will then call you himself the following day to check you are doing ok and answer any questions and make sure you are using your eye drops. He will see you back in clinic 1-3 weeks after surgery.

9. When can I exercise after the procedure?

You will be up and about and able to perform your usual daily activities the day after surgery. We advise that you resume light exercise 3 days after treatment, and full exercise 2 weeks after treatment to give your eyes a chance to settle after the procedure. You can go swimming 2 weeks after treatment but we recommend you wear goggles to prevent the chlorine irritating your eyes. After 4 weeks you can swim without any restrictions.

10. What are the risks of refractive lens exchange?

As safety and techniques have improved considerably, the risks of refractive lens exchange surgery have been greatly reduced. Specific risks will be discussed with you at the consultation and are written out in the consent form. The key is making sure you know and are comfortable and confident in the ability of the surgeon performing your surgery and understand his expertise in this area and his complication rate.

If you would like to see what our patients have said about this procedure please look at our patient reviews on our website or on the independent review site Trust Pilot or our social platforms.