Not everyone is a candidate for LASIK surgery. Factors ranging from age to eye health can affect your candidacy. If you want better eyesight and are open to undergoing a procedure for long-lasting results, you may be able to explore LASIK surgery alternatives if you don’t qualify.
One such alternative is Refractive Lens Exchange (RLE). If you have questions about cost, eligibility, and the procedure in general, read on for answers.
What is Refractive Lens Exchange?
RLE is a surgical procedure that’s identical to cataract surgery. In RLE, the eye’s natural lens is replaced with an artificial intraocular lens. This helps improve eyesight for people with high hyperopia, also known as farsightedness.
People who have myopia, or nearsightedness, but who are not candidates for LASIK may also be able to get treated with RLE. RLE may be the better alternative for patients with myopia and hyperopia who have a severe refractive error or abnormal cornea.
RLE may also be an alternative to reading glasses for presbyopia. Presbyopia is a common vision disorder that affects most people as they age, making it harder to focus on close objects. For older adults who have presbyopia but don’t qualify for LASIK, RLE may be an ideal solution.
Is Refractive Lens Exchange Safe?
Yes. RLE is just as safe as cataract surgery. Numerous RLE studies have demonstrated its safety across a wide range of patients.
Possible complications are rare, and if they do occur, they can usually be treated successfully with medication or additional surgery.
The similarities between RLE and cataract surgery mean there are similar risks, including:
- Eye infection or bleeding
- Increased eye pressure
- Retinal detachment
- Dislocated intraocular lens
- Glare, halos, and blurry vision
- Droopy eyelid
Discuss the risks with your eye doctor to determine if you are a good candidate for RLE.
Is Lens Replacement Surgery Painful?
No, RLE is not painful. Patients receive numbing anesthetic drops so they don’t feel anything during the surgery. Patients typically report immediate improvement in vision after surgery.
Are You Awake During Lens Replacement Surgery?
Yes, you are awake during RLE. However, again, you receive numbing drops so you won’t feel anything. The entire RLE surgery takes about 15 minutes and is performed in an outpatient environment.
Who is a Candidate for RLE Surgery?
You may be a candidate for RLE if:
- You are not a candidate for LASIK, photorefractive keratectomy, or Visian ICL
- You want to avoid wearing reading glasses because of presbyopia
- You are over the age of 40 and have not yet fully developed cataracts
- You want the desire to see clearly without having to wear glasses or contacts
Consult with your doctor about your possible candidacy.
Cost of Refractive Lens Exchange
Are you wondering if refractive lens exchange is covered by insurance? The answer depends on your insurance. Typically, elective surgery such as RLE is not covered by insurance. However, you may have access to a flexible spending plan through your employer that provides tax advantages for surgery upgrades. You may also have payment plan options or health care credit cards to help make RLE work for your budget.
Premium lenses, such as multifocal or astigmatism correction lenses, are an additional cost and may not be covered by insurance.
How to Prepare for RLE Surgery
Preparing for RLE surgery involves a few simple steps to ensure a successful procedure. Your ophthalmologist may ask you to:
- Consult with a doctor. Too determined to choose the lens type to use? Discuss your lifestyle and expectations with your doctor.
- Take an ultrasound test. This measures the shape and size of your eye to determine the appropriate lens implant.
- Stop taking certain medications. Certain medications may increase your risk of bleeding during the surgery. You’ll want to discuss all medications you are on well before your RLE surgery.
- Use eye drops. You may be prescribed antibiotic eye drops to use for a day or two before the surgery.
- Fast. Similar to many types of surgeries, you may be instructed not to drink or eat anything for around 12 hours before the surgery.
You will also want to arrange transportation for after your surgery because you will not be able to drive after RLE surgery.
Recovery and What to Expect After RLE Surgery
Like any surgery, RLE surgery will require some planning to ensure success and a full recovery afterward. Recovery after RLE is relatively quick and painless and takes anywhere from days to weeks. Here’s what to be aware of.
How Long Does it Take to Recover from Lens Replacement Surgery?
Typical recovery time after RLE is around one week, during which your eye doctor may ask you to limit certain physical activities, such as bending and lifting.
What Can I Expect After RLE Surgery?
After RLE surgery, many patients experience immediate improvement in vision. You may experience seeing brighter colors and a more vivid vision.
For some, vision may be blurry at first while your eye heals and adjusts. It’s normal to feel mild discomfort or an itchy eye for a couple of days after surgery, but you should avoid pushing or rubbing your eye. Your eye doctor may have you wear a protective shield or eye patch on the day of surgery and possibly for a few days after as you recover.
You may be prescribed eye drops or medication to prevent infection and control eye pressure. Within a few days, your discomfort should disappear.
You’ll have multiple follow-up visits after RLE surgery to monitor healing.
After about a week, you should be able to return to your normal physical activities. Complete healing takes about eight weeks.
Will I Need Glasses After Lens Replacement?
It depends. The type of intraocular lens that is used during your RLE surgery will affect your need for glasses.
If you receive a monofocal intraocular lens, you will be able to focus at a single distance and will likely need glasses for up-close tasks, such as working at a computer or reading.
If you receive a multifocal intraocular lens, your need for glasses or contact lenses may be reduced or eliminated. Talk with your eye doctor about which type of intraocular lens is best for your vision needs.
Can Refractive Lens Exchange Be Reversed?

RLE surgery cannot be reversed. Since the natural lens of the eye is removed, it cannot be replaced. However, know that complications from RLE are rare.
How Long Do Intraocular Lenses Last?
Intraocular lenses last a lifetime. You will not need to have subsequent RLE surgeries to replace the intraocular lens. The first one you receive is designed to be a permanent eye-care solution.
Learn More about RLE Surgery
If you have questions about how refractive lens exchange may improve your eyesight or think you might be a candidate for the surgery, consult an ophthalmologist. At Southwestern Eye Center, we offer Visian ICL™ for nearsighted patients. This FDA-approved corrective eye procedure involves placing an intraocular lens in front of the natural lens to correct your vision. The lens is invisible and undetectable, and the procedure takes less than 20 minutes.
To learn more about Visian ICL™, or to schedule an appointment with an ophthalmologist, call 480-616-0467.