Refractive lens exchange (RLE)

What is clear lens exchange?

Clear lens exchange, also known as clear lens extraction or refractive lens exchange, is an ophthalmological procedure that involves removing the eye's natural lens while it is still transparent and functional, and replacing it with an artificial intraocular lens.

This procedure is primarily performed for refractive purposes, to correct vision defects such as presbyopia, myopia, hyperopia or astigmatism, when other options such as glasses, contact lenses, laser refractive surgery (LASIK, PresbyLASIK, SMILE, PRK) or implantable contact lenses (ICL/IPCL) are not suitable or sufficient.

How is the procedure performed?

The procedure is similar to that performed to treat cataracts, but in the case of clear lens exchange, there is no clouding of the lens.

It is generally performed under local or topical anesthesia (anesthetic eye drops) on an outpatient basis and only takes 10 to 15 minutes per eye.

The technique used is phacoemulsification, which involves fragmenting and aspirating the lens using ultrasound before inserting an artificial intraocular lens (IOL), chosen according to the patient's visual needs:

• Monofocal: correcting vision at a single distance, usually far.
• Premium (multifocal or EDOF): allows simultaneous vision at multiple distances (far, intermediate, near) without glasses.
• Toric: corrects corneal astigmatism. Available in monofocal, EDOF, and multifocal versions.

What are the benefits of this procedure?

Long-term solution: Once implanted, the IOL provides permanent correction with no need for future replacement. It also prevents the subsequent development of cataracts.

Improved quality of life: Clear lens exchange reduces or eliminates dependence on glasses and contact lenses, thereby offering patients greater visual freedom.

Customizable lenses: Patients can choose from a variety of IOLs tailored to their needs, such as multifocal, trifocal, or extended depth of focus (EDOF) lenses, which can also correct astigmatism (toric), making clear lens exchange a versatile option.

Recovery

Recovery is similar to that of cataract surgery although generally faster because it involves a clear lens that is easier to remove with reduced operating time.

Vision is usually clear within days following the procedure, and antibiotic and anti-inflammatory eye drops are prescribed to reduce the risk of complications.

Possible risks and complications

Although cataract surgery is a very safe procedure, some rare complications can occur, such as:

• Weakness of the capsular bag or its supporting fibers (zonules): requiring IOL implantation outside the natural lens capsule, which can be done during cataract surgery or a subsequent procedure.
• Infection (endophthalmitis): risk of approximately 0.08%, characterized by intense pain, significant redness, and sudden vision loss requiring emergency treatment.
• Corneal or macular edema: delaying visual recovery.
• Retinal detachment: more common in patients with high myopia.

What are the adjustment options after surgery?

Implantation of an add-on IOL (or piggyback):

• A secondary intraocular lens is added in front of the existing IOL, in the ciliary sulcus, to refine the correction.
• This solution is reversible and allows for precise refractive adjustment (myopia, hyperopia, astigmatism, presbyopia).
• It is particularly indicated in cases of significant refractive errors or an evolving need for correction.
  

Laser correction:

• When the IOL is in place and further adjustment is needed, laser corneal refractive surgery (LASIK, SMILE, PRK) is effective.
• Used to correct mild to moderate residual refractive errors (myopia, hyperopia or astigmatism).
• Suitable for patients wishing to reduce their reliance on glasses after surgery.
• A quick, minimally invasive procedure with a short recovery time.

IOL explantation and replacement:

• In cases of major refractive error or intolerance to the initial lens, the IOL can be removed and replaced with a more suitable lens.
• This is a more invasive procedure, generally considered as a last resort.​​