Why does RLE cost more than LASIK?

Refractive Lens Exchange (RLE) is a complex way to simplify your vision. So is LASIK. Here’s why one costs more when both can free you from glasses.

Joel Hunter, MD
Joel Hunter, MD
Refractive Surgeon, Hunter Vision Updated 10/31/18 11:25 AM

*Hello! To skip the rambling preface about how I don’t enjoy discussing cost, feel free to skip to the asterisk at the end of paragraph three, where I begin the actual explanation…

I would have been the worst car salesman in the world. For one, I know so little about cars that I imagine I would be easily duped by customers. “So the Limited model is called that because it’s limited in its ability to be good at being a car? You’re right, this should be cheaper.” On top of that, my capacity to ask people to pay for something is almost zero. Customers would love me as a car salesman for the one day before I was fired. And I would definitely be fired because I did something like tell a customer their car was free because we were out of coffee and wanted to make it up to them.

When people ask me why RLE costs more than LASIK, it’s hard for me because of my disability in the realm of discussing price. I don’t go to work to sell RLE. I go to work to tell people about their eyes and fix the ones I can fix. It’s necessitated a pre-constructed answer along the lines of “there are other people here who can go through the details and they know way more about the money side of things than me. I just like eyes.” It seems like I’m dodging, but I’m not. I am so separated from the money side of Hunter Vision that it is exasperating to the people who run the business stuff. They’ll say, “we’ve been looking at our business stuff and made you a chart about all the business. Do you see how the business did business last quarter?” And I’ll nod sagely, reassuring them I can recount every word—as I have in the previous quotes I remember from our most recent meeting.

Ha! All of this preface was to say why it seems like a good idea to write a blog about why RLE costs more than LASIK. Since I dislike talking about it, getting some points down in writing should explain the medical reasons. Now as I look at what I’ve written, it appears I stall even when writing about it. No more though! *Now I will discuss why it costs more (and welcome to the folks who skipped to the actual explanation).

Medical costs can be for arbitrary reasons like prescription drug price gouging, the whims of qualifying for insurance coverage, etc. Most of the time, this is at least part of the reason for higher cost; it’s relatively random and based on if they can get away with it. It’s understandable then that folks should feel like RLE is another example of this. Honestly, it isn’t the case with RLE. It’s a medical expense at a level reflecting its cost to perform successfully.

To clarify, the cost to successfully perform any procedure in medicine is a result of three required components:




If you have less than enough of any of those three, you’re headed for a mistake. And while the threshold for each of those three is high with LASIK, it is measurably higher for RLE.  


The technology involved in correctly predicting the intra-ocular lens necessary—both by model type and also focusing power—is so complicated that it wasn’t possible at this level until recently. RLE can’t be done if excellent near and distance vision are “maybes.” For the 1 in 10 where the aforementioned technology only achieves 95% of our goal for vision, more technology is required to fix it. In those cases, super accurate LASIK results push the vision to the maximum. LASIK at those levels of accuracy is relatively rare because the technology enabling it expensive. And also because of the expertise required to achieve the best results possible.


That brings us to our second component—expertise. I’ll gloss over the awkwardness of the underlying, “I’m an expert,” subtext necessary in this explanation. But the truth is there aren’t many people who narrowed their expertise down into such an incredibly specific subject. The funnel of specialization in this scenario is doctor to ophthalmologist to anterior segment surgeon to refractive surgeon. The number of people in each specialty is multiplied many times over with each step up that funnel. This is true of LASIK, and even more true of RLE. There are far more doctors who perform LASIK than who perform RLE. That means finding a competent RLE surgeon is much more of a challenge. Adding to the challenge is finding one who is able to make you feel comfortable because that requires the last component.


Of all the moving parts and necessary details involved in successful RLE, time is king. Every step of the process requires uncompromising, thoughtful, purposeful time. This is true of the diagnostics involved—never allowing a “good enough” measurement instead of a perfect one—and true of the people involved. The time required to get it right, and to be personally guided through the process of getting it right, is expensive. And it is absolutely worth it. Nearly every patient I’ve seen for a “second opinion” about their RLE surgery, wasn’t failed by technology or even by expertise. It was time. Something was missed or poorly planned or explained, because time is valuable. It’s a bad place to save money.

My hope is for that to explain why RLE costs more than LASIK from the only perspective I am able to share. Technology, expertise, and time are the centerpiece of my job at Hunter Vision. For costs of each piece of technology or staffing or whatever else, you can find answers. You’ll just have to find the people in charge of business stuff. They speak the language of business stuff you may be seeking. And despite my expert cover of nodding sagely, I’m never totally clear on what they’re saying.

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