Procedures:Cataract / Refractive Lens Exchange

Refractive Lens Exchange (RLE) is an alternative procedure to laser vision correction and other refractive surgery procedures. It can correct nearsightedness, farsightedness, astigmatism and even presbyopia using new technology intraocular lens implants. Presbyopia is a progressive condition typically requiring individuals over the age of 40 to become dependent on reading glasses.
Traditional cataract replacement lenses offer very clear vision, but are typically focused only for distance vision. Most patients who opt for these lenses will require glasses to improve near vision or fine-tune distance vision. Many who receive these lenses are happy with their choice.
Lifestyle Lens
However, if freedom from glasses is important to you, you may want to
consider a Lifestyle Lens. These lenses are designed to restore your
clear vision and your youthful ability to focus on objects at varying distances.
These lenses can significantly reduce and even eliminate your need for reading
While many Lifestyle Lenses are implanted during cataract surgery,
they are often used to correct presbyopia in patients who do not have
cataracts. These patients will never face cataract surgery because,
unlike the eye's natural lens, an artificial lens will never develop a cataract.
Which Replacement Lens is Right for You?
RLE 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 may also be a viable alternative for those over the age of 40 who wish to reduce their dependence on bifocals or reading glasses.

This question can be answered only after careful consideration of the health of your eyes, your individual lifestyle, and the demands of your occupation and hobbies.

Before advising you, your surgeon will want to know more about:
o The kind of work you do.
o How many hours a day you read and what types of reading you do.
o How many hours a day you use a computer.
o Your outdoor activities.
o Your hobbies, and whether you do close work, like sewing or knitting.
o How much driving you do at night.
o Whether you like to travel.
o How bothered you are by wearing glasses.

Ultimately, the decision is yours. Ask yourself, What would my life be like without glasses?
Questions and Answers
If I have had LASIK vision correction. Am I still a candidate for a Lifestyle lens?
As long as your eye is healthy, you can have a lifestyle lens implanted, even if you have already had a refractive procedure like LASIK.
How does it work?
There are three anatomical factors that contribute to how well the eye can focus images: the curvature of the cornea,the power of the eyes internal natural lens, and the length
of the eye. Many vision correction procedures, such as laser vision correction, change the focusing power of the eye by changing the curvature of the cornea. RLE, on the other hand,
corrects vision by replacing the eyes natural lens with anintraocular lens of the appropriate power for each persons eye length and corneal curvature.
Who is a candidate for a Lifestyle lens?
Lifestyle Lens candidates are patients over age 45 who desire a full rage of vision in each eye without corrective lenses. Patients with health problems, such as diabetes or a chronic infection, should wait until those conditions are under control before scheduling this procedure. You may not be a candidate for a lifestyle lens if you have already undergone a cataract correction procedure. Your surgeon will perform a careful examination before making any recommendation. At that time, your eyes will be measured to determine the correct lens power for your forever lens.
What does the procedure involve?
RLE is usually performed as an outpatient procedure in our ambulatory surgery center. The primary difference between cataract surgery and RLE is that cataract surgery is performed to remove a patients cloudy lens, and RLE is performed to reduce ones dependence on glasses or contact lenses.
The eye is anesthetized to ensure patient comfort during the procedure and medications are given for relaxation. Todays modern surgical techniques allow surgeons to remove the natural lens from the eye, using ultrasonic vibrations through a microincision of 3 mm or less. The natural lens is replaced by the intraocular lens, which is inserted through the microincision. Once inside the eye, the lens unfolds and is placed into permanent position. No sutures are required because the small incision is self-sealing.
When can I resume normal activity?
Most patients can drive and return to work after only a few days. The eye may still be sensitive to touch and to light, and sunglasses are recommended for outdoor activity. Your surgeon will advise you regarding activities you should avoid while the eye is healing. Your vision will continue to improve over time as your brain adapts to your new intraocular lenses.
I have astigmatism. Am I still a candidate for a Lifestyle Lens?
There are lenses currently able to correct distance vision and astigmatism. This will eliminate your need for distance vision, but one would still need to use over the counter readers.
Can lenses be implanted in both eyes on the same day?
Generally, your surgeon will implant a lifestyle lens in one eye first, and then monitor the healing and vision of that eye before scheduling the procedure for your other eye. Often it will be only one week apart, since the vision is best with the Lifestyle Lens in both eyes.
Is the procedure to implant a lifestyle lens safe?
The lifestyle lens procedure is virtually identical to the cataract procedure that has been performed safely for the past 25 years on more than 65 million eyes in the U.S. Alone. RLE now will avoid cataract surgery later in life.
The clouding of the natural lens of the eye leading to a decrease in visual acuity is referred to as a cataract. This is usually an ageing process that will occur in all of us, presuming we live beyond our 50's and 60's. Cataracts can also result from trauma to the eye, medications and medical conditions that effect the metabolism of the lens in the eye, or be present at birth. The formation of the cataract and the decrease in vision is usually gradual (many years) but in some cases can be relatively rapid (few months). When the vision has diminished to point that the patient can no longer perform his or her normal daily activities properly, then it is time to consider the removal of the lens in an operation known as cataract extraction. This is the most commonly performed operation in medicare aged patients in the United States today.
It is highly, performed as an out-patient, and has very little recovery time. Over the past 50 years it has become commonplace to replace the clouded lens with a lens implant known as an IntraOcular Lens or an IOL. These lenses have become quite sophisticated and now have the ability to restore both the distance and near vision without the use of glasses in most patients. These IOLs are also referred to as LifeStyle Lenses in that they can most closely reproduce the natural vision that the patient had years ago, even before they started needing reading glasses. While they are no perfect and your surgeon will help you pick the lens type that is most appropriate for your lifestyle, they are major step forward when compared to the standard single focus IOL of the past. The single focus lens can provide very sharp vision but at only one focus area, ie., distance, arms length (intermediate) or reading, but the patient will require glasses for the other areas. Many exciting developments are occurring in the field of IOLs and we can expect to see more sophisticated lenses emerging from the FDA from now on.

When a patient has a very mild cataract that is not causing any real visual disturbance, or really doesn't have a cataract at all but wishes to avoid the development of cataracts, the natural lens may be removed in the same process that a cataract would be, but the surgery is then referred to as a Refractive Lens Exchange or RLE. While a true cataract that is causing significant visual disturbance is typically covered by insurance, RLE is not. Patients in the presbyopic age group, usually mid 40's and older, who are already wearing reading glasses and are not candidates for laser surgery, can also consider RLE as a viable option.
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