Refractive Lens Exchange with Tecnis™ IOL
Refractive Lens Exchange (RLE) is a surgical technique that is exactly the same procedure as modern cataract surgery, but is performed to correct nearsightedness (myopia), farsightedness (hyperopia), astigmatism and presbyopia, instead of correcting a clouding of the lens (cataract surgery).
After age 40, all human lenses begin developing some clouding, hardening and yellowing. This process is gradually progressive over many years, producing loss of ability to focus (the cause for reading glasses and bifocals), and eventually decreasing ability to see objects clearly at any distance, requiring cataract surgery.
In general, between age 40-55 or so, RLE is recommended over NuSite™ Advanced Surface Ablation when either the patient's cataract has progressed enough to decrease the quality of the surgical result with NuSite™, or the patient is interested in the Crystalens AO™ accommodating lens implant to restore focusing ability for both distance and reading vision without glasses. After age 55 or so RLE is usually the procedure of choice for most patients, since the cataract clouding is typically bad enough to cause problems with NuSite™ or LASIK results and the patient is closer to cataract surgery age already. Once RLE is performed, cataract surgery is no longer necessary during the patient's lifetime. So patients choosing RLE instead of NuSite™ or LASIK essentially avoid a second surgery later in life (cataract surgery)
There are three optional results using RLE. The first option is both eyes set for good distance vision without glasses, and then using reading glasses ("over-the- counter type that you buy without a prescription) for "up close" vision. This option uses the Tecnis™ aspheric monofocal (one focus) lens implant (IOL), which enhances excellent uncorrected distance vision by reducing "spherical aberration", a type of distortion caused by older technology IOL's.
The second option is the so-called monovision technique, in which one eye is set for distance and the other set for near. This technique also utilizes the Tecnis™ IOL to maximize visual quality. Some of our happiest patients utilize the monovision technique since these patients can function well without glasses in the majority of their daily activities. Most monovision patients only need to wear glasses with night driving. However, only approximately 50% of patients can adapt to this difference between the two eyes, with the other half being bothered by this effect (usually feeling unbalanced). We therefore always test this technique with contact lenses (one eye distance, one eye near) before deciding to proceed with monovision RLE (or monovision NuSite™ or LASIK).
The third option is RLE with the Crystalens AO™ accommodating (focusing) lens implant. This option is for the patient over 40, who wants good distance and near vision without glasses, but can't tolerate or doesn't want monovision. In this technique the lens implants are set for distance in each eye, but when the patient looks up close, the eye muscles contract causing the IOL's to focus. This produces a seamless type of natural vision for distance, near and everything in-between.
This RLE procedure is performed in our comfortable, safe and efficient in-office ambulatory surgery center which is state licensed, Medicare accredited, and AAAHC certified (the first eye center in southeast Virginia to achieve these designations). In this technique, a mild oral sedative is given to help you relax. The eye is then numbed with very effective topical anesthetic drops. The surgical procedure, which takes 10-15 minutes to complete, is quite comfortable, with the patient experiencing moving lights and colors but no pain. This micro-surgery is performed under an operating microscope, and involves the removal of the natural crystalline lens using ultrasound ("phaco-emulsification") energy followed by the insertion of an exquisite artificial lens called the intraocular lens implant (IOL). Afterward, you typically experience some mild scratchiness, which clears quickly, and begin using eye drops to control infection, inflammation and discomfort. Visual results are very rapid using this technique with better vision being noted usually within one day of surgery!
