Monday, January 31, 2022

RLE Surgery - A Permanent Solution to Reading Glasses

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So you want to get rid of reading glasses forever? that's the topic of today's article. I am here to bring you the latest information on eye health and medicine. The worsening of reading vision as we age is called presbyopia.

With the recent FDA approval of the vuity eye drop which is a temporary treatment for presbyopia. A lot of my patients have been asking me about ways to eliminate reading glasses permanently.

Refractive Lens Exchange Surgery (RLE)

In today's article, I will discuss a surgical option that can treat presbyopia permanently. This type of presbyopia eye surgery is known as refractive lens exchange surgery or RLE.


I will go over how RLE works? Who are candidates for RLE surgery? What to expect before and on the day of refractive lens exchange surgery? what is the recovery process and what are the risks of this type of surgery? Make sure you read the entire article to learn about both the benefits and risks of RLE surgery?

How Does Refractive Lens Exchange Surgery Work?

So how does RLE surgery work? RLE surgery corrects presbyopia by replacing the stiff and aging natural lens in our eyes with an advanced intraocular lens implant or IOL.

When we are young we are able to see objects at different distances due to the flexibility of our natural lens. Our natural lens becomes more curved when the eye muscles contract called "Ciliary body muscles" and our eyes become more nearsighted.

This enables us to see objects that are close to us clearly. In our early 40s, our lenses gradually lose their flexibility and no longer change shape as our eye muscles contract causing presbyopia. Although there is no currently available treatment to restore the elasticity of our natural lens.

Refractive lens exchange surgery treats presbyopia by removing the rigid lens and replacing it with an advanced IOL to give us a clearer range of vision including distance, intermediate, and near vision.

Who is a Good Candidate for RLE Surgery?

So how do you know if you are a good candidate for RLE surgery? In general, people who are over the age of 40 and have developed significant presbyopia or difficulty reading, may want to be evaluated by an eye surgeon for RLE surgery.

In order to be a candidate for RLE surgery, you need to have a healthy eye, free of significant eye diseases. For example, people who have glaucoma, macular degeneration, significant diabetic eye disease, a history of retinal detachment, eye inflammation, or any significant disease of the cornea, are not good candidates for RLE surgery.

People who are extremely nearsighted or farsighted with an abnormal length of the eye are also typically not good candidates for RLE surgery.

For example, in people who are extremely nearsighted with a glasses prescription over minus 15 diopters, the length of the eyeball is extremely long and this increases the risk of developing retinal detachment including RLE surgery.

What to Expect before RLE Surgery?

Retinal detachment with any kind of intraocular surgery including RLE surgery. So what can you expect during your evaluation for RLE?

In order to determine if you are a candidate for RLE surgery, you will need to have a full eye exam by your eye surgeon and complete extensive testing and measurements of your eyes.

Typically a full RLE surgery evaluation will involve measuring the curvature and length of the eye, a full eye exam with pupil dilation, examining the health of the optic nerve and retina inside of the eye. Also, the strength of the glasses prescription for both distance and near vision is recorded during the exam.

After the examination and testing, if you are a candidate for RLE surgery, your eye surgeon and you will pick the best advanced intraocular lens implant for your eyes. There are two main types of advanced IOLs that are currently available in the US for presbyopia correction.
  • Multifocal IOL (MFIOL)
  • Extended depth of focus (EDOF) IOL
The choice of IOL for each candidate is made based on that individual's functional vision needs as well as any vision requirements for their profession and lifestyle.

What to expect on surgery day and vision recovery after surgery?

What should you expect on the day of RLE surgery and how do you care for your eyes after surgery?

RLE surgery is typically done for both eyes either separately or occasionally at the same. It is an outpatient procedure that takes about 15 minutes for each eye and you will go home the same day.

During the surgery, patients are typically not under general anesthesia. They will receive IV or local sedatives to stay conscious but in a very relaxed state. The surgery itself is painless and patients will be using different types of eye drops with a tapered schedule in the weeks of the following surgery.

Strenuous activities should be avoided during the first week after surgery. In general, your vision will be blurry on the day of surgery. With a successful RLE surgery, your vision should be much clearer the day after surgery and you should be able to resume most of your vision tasks the day after surgery such as:
  • Watching television
  • Driving
  • Reading or light reading
You may feel very mild irritation or foreign body sensation in your eyes and may have some light sensitivity for about a week after surgery.

The majority of vision recovery occurs during the first week after surgery. But it is not unusual for you to experience small fluctuations in your vision during the first month after surgery.

Although mild irritation and vision fluctuation are expected shortly after surgery, significant eye pain and sudden significant vision change are unusual and can be signs of potentially serious complications. If you experience those or any other concerning symptoms, you should contact your eye surgeon right away.

For RLE patients, their vision stabilizes about one month after surgery. However, a small percentage of patients may take a few months to fully recover their vision after RLE surgery. Usually, patients will be following up with their eye surgeon or eye doctor a few times during the postoperative period.

The surgical steps of RLE surgery are basically the same as cataract surgery, and it can be done with a conventional manual method or with assistance from a femtosecond laser.

What are the Risks of Refractive Lens Exchange (RLE) Surgery?

Please remember, there are risks with any surgery including RLE surgery. With RLE surgery there is a small chance of infection, bleeding, increased eye pressure, glares at night, and potentially other risks that you should discuss with your eye surgeon.

Most of the complications from RLE surgery are treatable with additional medications or procedures. Although it is rare, the risk of vision loss is not zero with RLE surgery or any intraocular surgery.

The goal of RLE surgery is to reduce the need for reading glasses and to help you eliminate reading glasses for most of your vision needs. Most RLE patients do not need reading glasses after surgery.

However, people who spend a lot of time doing prolonged close-up work. for example, threading needles or reading very small print up close for hours at a time may still want to wear reading glasses for those tasks in order to reduce eye strain.

Therefore it is important for you to have an individualized exam and consultation with your eye surgeon to determine if RLE surgery is the right treatment for you. 

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