Refractive lens exchange replaces your eye’s natural lens with an intraocular lens (IOL) to correct refractive errors and improve your vision. As a result, you may not need to wear glasses at all, or you may need them only for certain tasks. Some people experience visual side effects like glare and halos, but these may lessen over time.
Refractive lens exchange is an elective outpatient surgery that removes your eye’s natural lens and replaces it with an intraocular lens (IOL). Like a contact lens or the lens of your eyeglasses, an IOL contains a vision prescription that’s customized to your eyes. The difference is that your provider permanently implants the IOL in your eye.
Once it’s in place, the IOL functions just like your eye’s natural lens. It refracts (bends) light as it enters your eye, helping it land properly on your retina so you can see clearly. Many people don’t need to wear glasses or contacts after their surgery, or if they do, it’s only for specific tasks like reading.
Refractive lens exchange offers an alternative to laser surgeries that change the shape of your cornea to correct your vision. Such surgeries, like LASIK and PRK, aren’t suitable for some people who have high refractive errors or certain eye conditions. If you’re not a candidate for corneal surgery, your provider may recommend refractive lens exchange.
An eye care specialist will evaluate your eyes and tell you if this surgery is appropriate for you. You may be a candidate for refractive lens exchange if you:
If you have any of the following conditions, this surgery may not be suitable for you:
Generally, the surgery is best suited for people over 40.
Ideal candidates are usually 40 or older because they may face a lower risk of complications. Also, the surgery is most helpful in people who have started to develop presbyopia because they’ve already lost some of the natural near-focus capabilities related to aging. Presbyopia typically begins after age 40.
Refractive lens exchange improves vision in people who have:
Both cataract surgery and refractive lens exchange are types of eye lens replacement surgery. This means a provider removes your eye’s natural lens and replaces it with an IOL. The main difference is the reason for the surgery:
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Your ophthalmologist will give you a pre-operative evaluation to check the health of your eyes and discuss your IOL implant options with you. They’ll perform a thorough eye exam, checking for any underlying conditions that could raise your risk of surgical complications. They’ll also talk with you about your lifestyle and preferences to learn what type of IOL is most suitable for you.
It’s essential to learn about available IOL options. Ask about the pros and cons of each type, and how each type will affect your day-to-day routine.
For example, multifocal IOLs improve your vision at multiple ranges, but they may cause glare and halos around lights. For some people, this is a minor inconvenience, while for others, it’s highly disruptive. Monofocal lenses typically avoid this side effect, but they can only correct for one range (like distance or near, but not both). So, if you have monofocal IOLs, you may need glasses for reading or other tasks that require precise close-up vision. Choosing to have one eye focused for distance and the other for near, called monovision, is a popular strategy for balancing these needs.
Talk to your provider to get all the information you need to make the decision that’s best for you.
To perform refractive lens exchange surgery, a surgeon:
The surgery usually takes 15 to 30 minutes.
Your provider will monitor you for about 30 minutes after your surgery ends. Then, you can go home. Make sure to arrange for someone to drive you home. You should also ask someone to drive you to and from your first follow-up appointment (typically the next day). At that point, your provider will tell you when it’s safe for you to drive again.
You may have blurred vision right after your surgery. That’s normal. Your vision will clear up quite a bit after several days. It’s also common to experience other temporary side effects as your eyes heal, such as:
You may notice visual side effects as you recover from your surgery. IOLs can cause such effects, and they’re not a cause for concern. You may notice:
These effects happen more often from multifocal IOLs compared to monofocal IOLs. Usually, they lessen over time. But if they greatly interfere with your daily routine, talk to your provider.
Like any surgery, refractive lens exchange has pros and cons. The main benefits are:
About 95% of people are happy with their vision after surgery.
Retinal detachment is the most serious complication of refractive lens exchange. Your risk may be higher if you have extreme nearsightedness or are under age 50.
Other possible complications include:
Talk to your ophthalmologist before your surgery to learn your individual level of risk and what you can do to lower the chances of any complications. In general, your risk of complications is lower when you receive care from ophthalmologists experienced in performing these surgeries.
It’ll take up to eight weeks for your eye to fully heal. But you should be able to return to most of your normal activities within a few days or weeks. Your provider will tell you how long you should wait to:
Your provider will prescribe eye drops to help your eyes heal. Be sure to use these drops according to the schedule your provider gives you.
Call your provider right away if the following side effects get worse rather than improve:
Seek care immediately if you have signs of retinal detachment. The sooner you receive medical attention, the better your chances of a successful repair.
Signs to look out for include:
Refractive lens exchange isn’t for everyone. There are other methods for vision correction that your provider may recommend first. The least invasive option is wearing glasses or contacts. But many people wear glasses or contacts for years and decide they don’t want to wear them anymore, or they want to wear them only occasionally. In that case, procedures that can help include:
If you’re not a candidate for laser vision correction or phakic IOLs, your provider may suggest refractive lens exchange. An eye care specialist can talk with you about the pros and cons of all these procedures and help you decide what’s best for your needs.
A note from Cleveland Clinic
Refractive lens exchange can help you see the world in a whole new way. But it’s not for everyone. Before scheduling your surgery, you should evaluate the pros and cons so you can make an informed decision. Talk with your provider to learn more about procedure details, IOL options and what you can expect in the months and years after your surgery.
Last reviewed by a Cleveland Clinic medical professional on 03/09/2023.
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