Refractive Lens Exchange

Refractive lens exchange surgery (RLE), also known as PreLex (presbyopic lens exchange), clear lens extraction (CLE) and permanent lens replacement surgery is a type of surgery performed to treat patients with reading vision difficulty. Refractive lens exchange offers a way of improving vision and reducing dependence on glasses for people who have problems with their reading vision and who aren’t suitable for laser vision correction.

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What is refractive lens exchange?

Refractive lens exchange eye surgery is the same as cataract surgery and involves replacement of the natural lens and implantation of a high definition Intraocular Lens.

This allows surgeons to correct and therefore eliminate myopia – short-sightedness, far-sightedness, astigmatism and presbyopia – reading vision problems.

Refractive lens exchange is most commonly performed in the context of reading vision correction in people over 50. The surgery is exactly the same as cataract surgery in terms of technique and is safe, sophisticated, and well established, as tens of millions of patients have had cataract surgery around the world. The purpose of lens exchange in a presbyopic patient is that it allows a trifocal or extended depth of focus intraocular lens to be placed within the eye. This allows the patient to be largely independent of spectacles for near and distance vision.

An added advantage of lens exchange surgery is that you won’t develop a cataract later in life.

Eye being draw in a tablet

The lenses

Premium IOLs

Premium intraocular lens implants, as used in refractive lens exchange, possess additional refractive properties above conventional monofocal intraocular lenses (IOLs). These IOLs typically have additional refractive properties are specially built onto one surface of the IOL optic.

Multifocal and Trifocal IOLs

Multifocal IOL and Trifocal IOL optics are divided into zones which are focused for distance, intermediate and near zones respectively. The most modern, technologically advanced lens options allow for a very high degree of independence from spectacles.

IC-8 Pinhole IOL

Allowing only focused light to enter the eye, the new IC-8 lens utilises a pinhole design and provides users with additional freedom from glasses for far, intermediate and near distance. These lenses are best suited to people who have had previous laser eye surgery, radial keratotomy surgery or who have unusually shaped corneas.

Ion Blended Vision

This involves using IOLs to correct the dominant eye for perfect infinity distance vision and the non-dominant eye for reading/intermediate. Customising the optics of the lens choice to the natural aberrations (imperfections) of a patient’s eye allows the lenses to work together to give patients independence from glasses for most activities except close reading.

Toric IOLs

Toric IOLs correct astigmatism as well as myopia and hyperopia. They need to be implanted in the correct position corresponding to the area of greatest corneal curvature. Monofocal, trifocal and extended depth of focus lenses.

My eyes weren’t receptive to contact lenses or suitable for laser treatment, but a refractive lens procedure could be completed. The surgery went smoothly and within 24 hours I was out and about. The aftercare was excellent, and I don’t spend all day running around trying to find my glasses!

– Fiona

RLE consultation

Before refractive lens exchange (RLE) surgery, you will have a consultation at our clinic. This will establish that the procedure is the best one for you, and ensure that we correct your vision accurately. We do not perform the surgery on the same day as the appointment as we have to order the right lenses for your eyes, based on your test results.

We recommend that you do not drive on the day of the refractive lens exchange consultation. We will use drops to dilate your pupils so we can check the back of your eyes, and this can make your vision blurry.

During your consultation, a specialist technician will carry out diagnostic tests on your eyes, and you will have a full eye test with one of our optometrists.

After the tests, you’ll meet your surgeon who will go over the test results with you and discuss treatment and lens options to make sure that your care plan is right for you and your needs.

You can then book your surgery appointment. We will give you a consent form for the procedure which you need to bring back with you on your surgery day. We will also give you an information pack to read at home, although you are welcome to get in touch with us directly if you have any questions.

Contact lenses

Please note that you cannot wear contact lenses prior to your consultation or surgery. This is so we can take accurate measurements of your eye. You cannot wear soft lenses for 3 days before your consultation, and you cannot wear gas permeable lenses for four weeks.

Your lens replacement surgery

  • Once at the clinic, the nurses will use drops to dilate your pupil(s). A nurse will discuss the aftercare with you, explaining the eye drops and how to look after your eyes immediately after treatment and in the days that follow.
  • We will collect your signed consent form before you see your surgeon again to talk through the treatment.
  • We can do both eyes on the same day if you meet the criteria for this, otherwise we’ll do one eye at a time.
  • Anaesthetic eye drops will be put in your eyes to numb them. Most of these procedures are carried out under local anaesthetic, although a general anaesthetic or sedation may be used in particular circumstances. The surgery then takes approximately 10-15 minutes per eye. After surgery, you will rest back on the ward for 30-45 minutes.

Immediately after surgery

Your surgeon will check your eyes again before you leave the clinic after your lens replacement surgery. You’ll go home wearing your sunglasses, and we recommend bringing a friend to help get home a little easier. Your eyes will feel tired and gritty for the rest of the day so we advise you to stay at home and rest.

You will be able to see afterwards, but your vision will be slightly misty for 48 – 72 hours. Depending on what the vision was like before, you may notice a dramatic improvement straight away.

RLE aftercare

RLE aftercare involves a comprehensive system of drops and advice from our team. At the clinic, you will be given anti-biotic and anti-inflammatory eye drops to use at home. You will also receive clear eye shields to wear at night for the first two nights after surgery. We will give you full instructions on how to use them, as well as written details for reference. You are also welcome to telephone our admin team if you have any queries.

Whilst RLE is a routine, low-risk procedure carried out in a single day, it is important to remember that you have undergone surgery and you need to take things easy for a few days afterwards. You can start to do light exercise after three days, and enjoy your full exercise regime again after two weeks. You also need to wait two weeks before you can go swimming, and you’ll need to wear goggles for swimming until four weeks after your surgery.

You can drive again whenever your vision has cleared and you feel ready. For most people, this takes a few days, but may take longer.

We do not recommend air travel until one week after surgery.

If you like to wear eye makeup, please wait at least a week after surgery before you start using it again, particularly mascara and eyeliner.


Life after RLE surgery

A month after RLE surgery, you should be able to resume all your usual activities – many, including driving and going to work, you can pick up again in less than a week.

The difference will be that you can exercise, travel, and wake up in the morning while seeing clearly, all without the need for glasses or contact lenses. Life will go back to normal very quickly, but it’ll be a better kind of normal than before.

Our surgeons are at the forefront of technology and have been voted by their peers as the best in their fields

In 2018, OCL surgeons, Allon Barsam, Romesh Angunawela and Ali Mearza were voted by their peers as some of the UK’s best lens surgeons following a National survey of eye surgeons by the Daily Mail. They are regularly consulted by industry and feature on advisory boards for new technologies. It’s a testament to our surgeons that we’re trusted the world over to test and use new technology, and that we’re involved in pushing lens and laser eye surgery to exciting new possibilities.