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Refractive Lensectomy (Clear Lens Exchange)

Refractive Lensectomy is an alternative procedure to laser vision correction and other refractive surgical procedures. It corrects nearsightedness, farsightedness, and presbyopia by replacing your natural lens with a clear intraocular lens implant of the appropriate power of correction. Presbyopia, a progressive condition typically requiring individuals over the age of 40 to use reading glasses, can be corrected using a multifocal lens implant.

Millions of eyes have received intraocular lens implants when undergoing cataract surgery, using the same highly successful surgical techniques used in refractive lensectomy. This procedure may be the procedure of choice for patients who are too nearsighted, too farsighted, or have corneas that are too thin for laser vision correction. It is a viable alternative for those over the age of 40 who wish to eliminate their dependence on bifocals or reading glasses and for those individuals who may be showing early signs of cataracts.

Refractive lensectomy is performed just like cataract surgery, and requires no needles, no stitches, and no patches. It is an outpatient procedure that takes approximately 12 minutes and can be performed in one of our own surgical centers. Because it is an elective procedure, medical insurance will not cover the procedure.

FREQUENTLY ASKED QUESTIONS

What is refractive lensectomy?
Most refractive procedures attempt to correct vision by changing the shape of the cornea (the clear dome-shaped surface that covers the front of the eye). Refractive Lensectomy, however, corrects vision error by replacing the lens inside the eye with an artificial intraocular lens (IOL) implant with the correct power for the eye. This procedure is performed using the same technology as modern cataract extraction, the most commonly performed outpatient surgical procedure in the United States. The main difference between standard cataract surgery and refractive lensectomy is that cataract surgery is used to extract a cataract that is obstructing a patient’s vision, while refractive lensectomy is performed to reduce a person’s dependence on glasses or contacts.

How is surgery performed?
After being given an IV sedation along with numerous numbing, antibiotic, and anti-inflammatory eye drops, your surgeon will create a tiny incision (about 3mm, or the size of the tip of a writing pen) on the side of the cornea. A tiny probe is then inserted through the incision to emit ultrasound waves that soften and break up the natural lens so that it can be removed by suction. After the natural lens is removed, it is replaced by an artificial lens. The clear, plastic lens requires no care and becomes a permanent part of your eye. Light is focused clearly by the implant onto the retina, improving your vision. You will not feel or see the new lens inside the eye. The entire procedure takes about ten minutes.

Is the surgery painful?
This procedure is essentially painless. You will be given an IV sedative and your eyes will be numbed with anesthetic eye drops. You will be awake for the procedure, but in a sleepy, dream-like state. Some patients may experience a feeling of light pressure from the lid speculum (the instrument used to hold your eyelids open), but you should not experience any pain. If you should feel uncomfortable during the procedure, you may be given more IV sedation.

Will you be cutting the cornea?
Refractive Lensectomy requires that a very tiny incision, roughly 3mm in length, be made on the outer edge of the cornea. Your surgeon may also elect to make micro-incisions, called limbal relaxing incisions (LRIs), on one or two sides of the cornea in order to reduce astigmatism. Since the incision is “self-sealing” it usually requires no stitches. It remains tightly closed by the natural outward pressure inside the eye. This type of incision also heals quickly and comfortably.

Will both eyes be done on the same day?
No. Refractive Lensectomy is typically performed on one eye at a time, generally one week apart. The surgery heals very rapidly in most people and vision can be excellent even on the first day, but sometimes vision will be blurry for a few days. Most patients see well enough after the first surgery to function without glasses for the week in between. Contact lens wearers can wear their contact on the untreated eye up to three days before the second surgery.

Can Refractive Lensectomy correct presbyopia (need for readers)?
Presbyopia, or “aging eyes,” is the common vision condition in which the natural lens inside the eye loses its flexibility, making it difficult to focus on close objects. When the natural lens is replaced with a clear, monofocal lens implant to correct distance vision, patients will require the use of reading glasses for near objects. There are different types of implants, however, including multifocal implants designed to provide good distance vision and near vision using concentric rings of alternating power. Studies have shown that the vast majority of people who receive multifocal lenses are able to read without glasses, but with some chance of experiencing difficulty with night driving, halos, and glare. The multifocal lenses are best suited for hyperopic (farsighted) patients or those with higher amounts of myopia (nearsightedness).

Will I ever need glasses or contacts again?
Although the goal of refractive lensectomy is to improve vision to the point of not being dependent on glasses or contacts, we cannot guarantee that your vision will be 20/20 following the procedure. You should understand that your eyes may continue to change as you age, possibly causing you to develop myopia (nearsightedness), hyperopia (farsightedness), or presbyopia (the loss of reading vision) over a length of time, though it is rare. If a monofocal IOL is implanted, you will need reading glasses to see close objects. If a multifocal or accomodative IOL is used, you may need reading glasses occasionally for very small print.

Will I still develop cataracts?
A cataract is the clouding of the crystalline lens inside the eye usually caused by aging, preventing light from properly focusing on the back of the eye. Since Refractive Lensectomy is performed by replacing the eye’s natural lens with a clear, plastic implant, your lens will not develop into a cataract. Sometimes after surgery, the capsule that holds the implant inside the eye can become hazy and cloudy, resulting in blurred vision, glare from light, or other problematic symptoms. A painless laser procedure called a YAG capsulotomy may be necessary to clear any haze from the capsule. This procedure can be performed 90 days after a Refractive Lensectomy and is usually covered by medical insurance.

What are the risks of the procedure?
As with any surgery, Refractive Lensectomy poses risks, such as infection and bleeding, though the risk of severe complication or even blindness is less than 1%. Before surgery, your doctor may ask you to temporarily stop taking certain medications that increase the risk of bleeding during surgery. After surgery, you must keep your eye clean and use the prescribed medications to help minimize the risk of infection and inflammation. Refractive Lensectomy slightly increases your risk of retinal detachment, which is a medical emergency and must be treated immediately.

Are there certain restrictions following surgery?
Most patients are able to return to work and other normal activities one to three days after surgery. You should be prepared to use eye drops for a few weeks after surgery to prevent infection and help the healing process. Although recovery is fairly quick, it is advisable to be careful with your eyes and avoid any strain. We also request that patients avoid lifting heavy objects, bending below the waist, and getting water in the eyes for two weeks following surgery.

Will I have to wear eye patches following the procedure?
You will not have to wear eye patches or bandages. However, you will be required to wear a clear, plastic eye shield over your treated eye when sleeping for two weeks following surgery. The eye shield is necessary to protect the eye from pressure and rubbing until the incision is fully healed.

Does the surgery need to be repeated periodically?
One of the best things about refractive lensectomy is how stable your vision is following the procedure. One of the primary reasons why your glasses prescription changes later in life is because of changes that naturally occur in the crystalline lens of the eye. When the natural lens is replaced, vision is much more stable. You will never develop a cataract later in life since the natural lens has been removed. In some cases, however, laser vision correction, or astigmatism surgery may need to be performed to help fine-tune results.

What is monovision?
Monovision is a specific situation where one eye is focused at distance and the other is focused at near. Some people have this naturally while others choose this method of correction when their reading vision worsens after the age of 40 either by wearing contact lenses or by vision correction surgery, including lens implants. Monovision is a great option for many individuals, but it is not for everyone. Your doctor will help determine if monovision is right for you.

How much does it cost?
The surgery fee for Refractive Lensectomy at Southern Eye Associates varies based on which lens you qualify for. This includes your pre-operative and post-operative care for six full months. We accept Visa, MasterCard, Discover Card, and American Express credit cards. Because RLE is considered elective surgery (cosmetic), most health insurance plans do not cover it. However, Southern Eye Associates also offers financing through CareCredit. Visit them at www.carecredit.com .