Refractive Lens Exchange
LASER-FREE VISION CORRECTION
Turning back the clock by rejuvenating your vision
Refractive Lens Exchange (RLE) is an excellent approach for older people to get rid of their spectacles and contact lenses for distance vision and increase their range of focus so that they hardly ever need to use reading glasses.
Many patients achieve complete independence from glasses. It is the crystalline lens inside the eye which causes the aging of our vision – the need for varifocal glasses, reading glasses or longer arms.
With Refractive Lens Exchange (RLE) we are replacing the natural lens which has become rigid. We use all the technology at our disposal at Custom Vision Clinic to work out whether our patients will be best served by RLE or by Presbyond blended vision LASIK laser eye surgery.
For patients who are showing signs of cataract change in the natural lens, the best option is usually refractive lens exchange. This is essentially early cataract surgery with the aim of removing the early cataract lens change and replacing the natural lens with technology which provides improved focus at all distances.
There are different lens designs to help us achieve this for our patients:
- Multifocal lenses
- Extended Depth of Focus (EDOF) lenses
- Lens implants which control spherical aberration (bluriness at the edge of your vision)
There have been lens designs in the past which attempted to mimic the movement of the natural lens in order to create a range of focus (accommodative lenses such as the Crystalens) but the long term results which these lenses could achieve were inconsistent, so they are no longer used.
Read on for more about the lens replacement procedures, and the different types of lens we use.
What conditions can be treated using lens replacement surgery?
What refractive lens exchange treats:
How does the refractive lens exchange (also known as lens replacement) procedure work?
How successful is lens replacement?
Multifocal lenses present both the distance focus and near focus at the same time onto the retina at the back of the eye.
Processing of the images by the brain begins in the retina and in the vast majority of patients is able to provide comfortable distance vision without glasses and comfortable reading vision without glasses.
Approximately 1% of patients find difficulty with having both distance and near images in focus at the same time in the eye and for these patients we use blended vision (outlined below). Multifocal lenses provides a very high level of independence from spectacles (90% of patients do not require glasses for any activity).
Multifocal lenses create a range of focus with rings on the optic of the lens. These fine rings create a halo effect around point sources of light but this effect gradually reduces with time. A small percentage of patients have difficulty with the halo effect and for these patients we can again use a blended vision approach with extended depth of focus (EDOF) lenses instead.
The images below illustrate how the multifocal lens (Panoptix) splits the light into a distance and a near focus whereas the extended depth of focus lens (EDOF) (IQ Vivity) extends the range of focus from distance to intermediate.
Extended Depth of Focus Lenses (EDOF)
The concept of extended depth of focus lenses has been around for quite some time.
The latest EDOF lens design provides very high-quality vision in all light environments including when driving at night. If the lens is set for clear distance focus then the extended range provides good intermediate vision without spectacles also.
Intermediate vision typically includes being able to see the dashboard of the car, read text on a desktop computer and see what you are eating when seated at a dining table. We can increase this range of focus by asking each eye to do a slightly different job.
We set the dominant eye to provide distance through to intermediate vision and the non-dominant eye to provide intermediate through to near vision. The extended range of focus in each eye provides an overlap which helps the brain blend the eyes together to provide a seamless range of focus.
This set-up provides social independence from glasses with many patients achieving complete independence from spectacles.
Spherical aberration modulation lenses
Spherical aberration modulation can be achieved by carefully measuring the shape of the cornea (the window at the front of the eye) and selecting a monofocal lens implant with a shape which compliments the cornea.
Spherical aberration is actually an imperfection in the sharpness of focus achieved by a lens, but like so many things in life, the imperfection actually has a benefit. The spherical aberration slightly increases the depth of focus provided by the lens and we can use this to increase the range of focus of the eye.
This approach is particularly beneficial for our patients who have had laser eye surgery when they were younger.
In the majority of cases the corneal shape created by the laser eye surgery provides a beneficial increase in depth of focus which we can further improve with appropriate choice of monofocal lens implant technology.
Frequently asked questions about refractive lens exchange
Results at a glance
My eyesight following the operation is brilliant and better than I thought possible, and this is all down to your excellent surgeon Mr James Ball and not to forget all the very dedicated people around him who make these operations possible.
Two of the best decisions I ever made in my life were firstly to have lens exchange and secondly to have Mr James Ball carry out my operation.
Within minutes I could tell there was a difference. But now, only a couple of months later, my sight is better than it was seven years ago! I can even read the really tiny print on the car sales ads! If you want that confidence you probably felt when you were younger, this is the ideal solution. Thanks to the treatment, I feel rejuvenated, independent and much younger!
Many thanks for all your care and kindness. To me it appears a miracle that I can see so well. I feel very grateful. It is impossible to fully express my thanks.
May I offer grateful thanks for your expertise in operating on my eyes. It was intimated to me that you were the best, and from the results I am now enjoying, I am convinced that this is correct.
You are truly innovative. Thank you very much for curing the problems I have been having with my reading and near vision.
My work was becoming almost impossible. I had refractive lens exchange to both eyes with multifocal lens implants last July. I can now see better than 20/20 for distance and can read the tiniest print in newspapers - all without glasses! I have started reading for pleasure again, and I feel that my performance both at work and on the golf course has improved.
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I felt I was treated as an individual and all my questions were answered. From my experiences – I can highly recommend Mr Ball.
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