What is Refractive Lens Exchange (RLE)?

With Refractive Lens Exchange (RLE), you don't have to wait until your eyes don't work. You can fix the problem before it starts because you want to.

Joel Hunter, MD
Joel Hunter, MD
Refractive Surgeon, Hunter Vision Updated 10/31/18 11:36 AM

As you discover the details of RLE, you’ll usually end up with a question that’s something like, “How is this different than cataract surgery?”

There’s a good reason for that. As a procedure, there is a lot in common between RLE and it’s cousin, refractive cataract surgery. The big difference is the involvement of a cataract. With refractive cataract surgery, you can’t see well enough with your glasses to do what you’d like, so you have surgery to fix it and get out of glasses altogether.

Fix the Problem Before It Starts

With RLE, you don’t wait until that point. Your eye’s natural lens has started to become annoying enough to your vision that you now require glasses or bifocals. The idea of waiting until it is bad enough for your vision to be poor even with glasses doesn’t appeal to you. That’s why RLE exists.

The lens inside your eye is destined to become a cataract over time. It gets cloudier each year, noticeably so after age 50, and a cloudy lens is the same thing as a cataract. There is a window of time, however, where the lens is cloudy and dense enough to cause trouble, but not enough to be officially called a cataract.

The symptoms of this stage of dysfunction for your lens are uniform across all people who have: 

          • a need for reading glasses or bifocals

          • difficulty reading in low light compared to bright lights

          • difficulty driving at night with the ease you once had

RLE is the solution to these annoyances because it doesn’t require waiting until the lens has become so cloudy it impairs you.

RLE Compared to Cataract Surgery

Cataract surgery has been around since the ‘50s, and it cures the problem of visual impairment due to a cloudy lens. As it improved, refractive cataract surgery was born. It could solve the cloudy lens problem, and as a bonus, it also gave vision that didn’t require glasses for near or far after surgery.

RLE requires a different standard of accuracy than refractive cataract surgery, however, so it didn’t become popular till much more recently. There’s a big difference between trying to fix an eye that has poor vision with glasses and fixing an eye that has good vision with glasses.

Remove the Need for Glasses

The idea of RLE is to remove a dysfunctional lens and replace it with a lens that doesn’t need glasses. That simple idea requires a tremendous amount of accuracy for it to work. The measurements before surgery, while they only take a few seconds, give so many hundreds of data points with such accuracy that they allow calculations for the new lens implant not previously possible. The measurements during surgery are similar. A few seconds, and an invisible light interprets several hundred data points from your eye to determine the proper lens to correct your vision. These technologies weren’t available until a few years ago.

The reason a discussion of RLE always ends up back at the idea of measurements and planning is that the surgical details themselves aren’t much different than cataract surgery. And that’s good news. Cataract surgery is one of the safest, highest-satisfaction procedures in all of medicine. Since it’s been performed millions of times per year for several decades, those stats have been achieved by fine-tuning and furthering the safety standards to near perfection. All that was needed was the ability to match all that tech with diagnostics that could provide a reliable way to plan for lenses that remove the need for glasses. And to do with the exceptionally high standard required for eyes that already see well with glasses.

A Preventive Approach

So to sum up,  RLE is a procedure to get an eye that sees distance and near. It is the ability to do that by using measurements so precise that we can choose to do it electively. The bar for dysfunction of your natural lens can be easily cleared at a stage when glasses still fix the problem—when glasses themselves are the problem. All this means you don’t need to wait to get new lenses because you have no other choice, but can fix the problem before it starts because you want to.

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