Multifocal Lens Replacement
About Refractive lens exchange
RLE (Refractive lens exchange) typically is suitable for people with presbyopia or extreme farsightedness, for whom LASIK, PRK or phakic IOL surgery doesn’t works. If you have both presbyopia and moderate to severe hyperopia, RLE may be the only viable option for clear vision and minimal reliance on glasses after refractive surgery. Lens replacement surgery also can correct myopia (near-sightedness), but generally it is not recommended when LASIK, PRK or phakic IOLs are available. 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. As in cataract surgery, three types of IOLs are available to replace your natural lens, depending on your vision needs and the health of your eyes. They are:
Benefits of the Refractive Lens Exchange
Refractive Lens Exchange surgery process
RLE is performed using drop anaesthetic supplemented by an injection in the back of your hand to relax you if required. Anaesthetic may also be washed around the back of the eye to prevent excessive eye movement. A spring clip holding the eyelids apart allows you to blink safely during surgery.
Your surgeon will be looking through a microscope to perform the surgery. You will be lying down under a surgical tent with fresh air coming in underneath. A sticky plastic drape covers the skin around your eye and sticks the eyelashes out of the way. Some centres offer surgery for both eyes on the same day. More commonly, second eye surgery is delayed for a day or longer to ensure that the recovery in your first eye is progressing well. The focus outcome in your first eye can also be used to help guide IOL selection for your second eye.
The surgery typically takes about 20 minutes per eye. You can return home on the same day as surgery Strong pupil dilating drugs are given as drops or as a pellet placed under the lower eyelid to prepare your eye for surgery. Essential steps in surgery are:
Step 1 -Entry points
formation of small self-sealing entry points in the front of the eye at the junction of the white of the eye and the cornea
Step 2 - Capsulotomy
removal of a circular disc from the front of the membrane covering the natural lens called the lens capsule (think of the skin of a grape and you will have the right mental image of the thin, clear covering of the natural lens)
Step 4 - IOL insertion
injection of the IOL and unfolding into the natural position within the lens capsule using a supporting gel to fill the front of the eye
Step 3 - Wash out and refilling
wash-out of the supporting gel and refilling with fluid and antibiotics Femtosecond lasers are sometimes now used in a preparatory stage before going through to the operating theatre. Femtosecond lasers are costly and provide no proven benefit for your vision after RLE or cataract surgery, but they may make some stages of the operation (capsulotomy in particular) easier for surgeons to perform safely and consistently. This additional laser stage takes about five minutes, and is performed using eye-drops to anaesthetise your eye.
On the path to full recovery patients may experience a few episodes of discomfort such as blurred vision, halos and glare. Most patients can go back to work within a week of the surgery, although you may need to wait 2 weeks before driving again – your surgeon will guide you on this.
You will not be able to see an artificial lens within your eye as it is placed on your eye, unlike a contact lens. The lenses are meant to last a lifetime as there is a negligible risk of regression (deteriorating of corrective vision) due to factors related to ageing. If problems do arise, the lens can be replaced easily without any permanent damage being done.