Refractive Lens Exchange

Restoring near vision: RLE or LASIK?

If you hate your reading glasses, there’s hope! Refractive Lens Exchange (RLE) is a laser eye surgery that can eliminate your need for readers.

Joel Hunter, MD
Joel Hunter, MD
Refractive Surgeon, Hunter Vision Updated 10/31/18 11:18 AM

I meet folks every day who’ve worn glasses since they were little kids and grown to really dislike them. They use words like “annoying” or “inconvenient” and they usually are excited about the idea of a procedure that could take away their need for glasses.

It’s different, however, for people who just started needing glasses in their 40s. They don’t dislike their glasses, they despise them. They use words like “horrible” or “depressing”—words with emotional power and sometimes violence to describe their deep-seated, fevered hatred of their glasses. They aren’t so much excited about a solution to get them out of reading glasses as they are desperate for a way to be rid them.

It’s possible you found this article because you’re one of those glasses-hating folks; maybe you’re reading these very words through reading glasses that make you miserable enough to Google “how to get out of reading glasses.” However you got here, the important thing is that you did! The challenge of getting rid of reading glasses these days is usually less about options, and more about finding out they exist.

Obscure scientific discoveries mean better vision for you

For any very sub-specialized field, there are updates and new pieces of information that make big waves within a very small world and barely a ripple outside it. I bet something huge has happened within the world of, oh let’s say, molecular genetics in the last 10 years, but I couldn’t tell you what it was because I don’t live in that world.

It takes decades for those big discoveries in a niche field to accumulate and refine before something new gets out and changes the world. Then all of a sudden one day, we have synthetic insulin. Refractive surgery is one of those sub-specialized fields, and for years the big headlines in that small world have been about advances in fixing reading vision.

The improvements have been accumulating, and getting more refined over time, to the point where we’ve reached a landmark achievement: we can permanently fix reading vision now. All of a sudden, we have Refractive Lens Exchange.

Refractive Lens Exchange is not Cataract Surgery—it’s the future of medicine

It’s important to point out why this isn’t simply relabeling of an old procedure. Lens exchange has been around for a long time. It’s usually a cloudy lens called a cataract getting exchanged for a clear lens, and that procedure is called cataract surgery. And while it’s true that the accuracy of cataract surgery has been ever-increasing, there’s a wholly different standard of precision required for replacing a clear lens with the expressed purpose of enabling reading vision.

The difference may be easier to see if we talk about another type of replacement procedure, like knee-replacement surgery. It’s easier to see the difference here because the analog for Refractive Lens Exchange doesn’t exist in the world of knee replacement (yet). It’s life changing to have a frozen arthritic knee replaced when you can’t walk, but it’s crazy to imagine replacing your knees if the reason is that you’d like to make a daily five-mile run easier.

The purpose of cataract surgery is to restore vision for people that can’t see well enough to be safe even when they’re wearing glasses. It shouldn’t be confused with the far higher bar set by Refractive Lens Exchange. In a giant leap from days past, people can decide that they don’t like wearing readers and have a surgery to fix that problem. The question of whether or not the vision is bad enough to stop driving at night never has to be answered, and down the road it’ll never need to be asked.

RLE gives you options where there were none before

The development of Refractive Lens Exchange has ramifications for a lot of people. The reality is that as long as we’ve been able to correct vision with surgery, people with the need for reading glasses have been a disenfranchised group when it comes to options. It’s true that LASIK, with technology upgrades over the last 5-10 years, can help many of them; but the majority of near-vision impaired folks still aren’t LASIK candidates most of the time.

In a Catch 22, the only way to be sure you’re making the right choice in choosing LASIK to fix reading vision is if the standards are set high enough that the odds are low you’ll be a candidate. Because the candidacy for RLE is based on different diagnostics entirely, those who were (wisely) counseled against LASIK to fix reading vision have a new option. And while there are still candidacy requirements to help ensure predictable results, it almost always ends up that the restrictions barring you from LASIK are actually helpful in making RLE a good option. Probably the best example of this is being over the age of 50. In short, now there are options for people who didn’t have options.

Why you don’t have to wait for RLE to get “better”

It’s also important to point out a key principle in how options in the refractive surgery field (or any field) should be determined viable or not. If there’s no reasonable expectation for a new development that would better meet your vision goals, and the benefits satisfactorily dwarf the risks, then RLE is now an option.

As refractive surgery technology advances, the result is often a widening of the net to help people who couldn’t be helped before, rather than improving choices for people who’ve already had them. Here’s an example: I meet patients every day who are over 50 and have poor reading vision, but they aren’t RLE candidates yet because in their situation something better is coming down the line. The net hasn’t widened out for them yet.

The people who are candidates for this procedure are the ones for whom we can reasonably know there isn’t going to be a time 10 years from now where they wish they’d waited. It’s different than iPhones coming out each year with more and more features. In RLE, glasses-free distance and near vision is a “yes” or “no” possibility, with very few (but still predictable) cases of “yes, but even distancer and nearer in a few years.” And this isn’t just because distancer isn’t even a word.

A fix for the flaw in your lenses

There’s a reason the capabilities we’ve been talking about apply to such a large group of people: it’s because we all have lenses in our eye allowing us to focus up close, and they all have the same flaw.

While every lens works beautifully when the sun still shines on our youth, it’s working up against a deadline. That lens gets progressively more stiff and “stuck” over time, causing a loss in autofocus necessary for reading. It hits most people at some point during their 40s and can be overcome with a boost in near vision from LASIK in those early days.

But throughout people’s 50s and 60s, there’s a point where the lens has long since lost its ability to focus up close, but still isn’t a cloudy cataract yet. It’s an incredible development for a lot of folks that we can finally fix the problem at the source. It’s like having the sun shine on our youth again, but in this version there’s more wisdom and also an appreciation for the ability to read shampoo ingredients that was absent the first time.

A lifetime of reading, free of reading glasses

While the idea of replacing that lens (like we mentioned with cataract surgery) isn’t new at all, the accuracy achievable today is. It gives us the ability to preemptively fix the lens before it gets worse, and place a new lens that enables focused vision at near distances.

Refractive Lens Exchange surgery takes about 20 minutes to do and recovery usually happens overnight, leading to results that last a lifetime. Additionally, since we now have the ability to perform laser aberrometry (which deserves an article to itself) during the procedure to guide the prescription settings for the new intra-ocular lens, both eyes can be done at the same time. All of this, and a myriad of other details that would make this article so long no one would read it, leads to the main reason I wrote this in the first place.

If you’re one of those people I mentioned at the beginning who hates reading glasses, you might finally have a way out of them. Refractive lens exchange can fix reading vision by exchanging your lens—with its reading days behind it—for a lens designed to durably, permanently keep all your reading days in front of you.

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