Refractive Lens Exchange

What is Refractive Lens Exchange?

At Visionary Eye Surgeons we have helped many patients who suffer from refractive errors or visual disorders that hinder their overall visual health. We provide a range of procedures, including refractive lens exchange (RLE), which we generally recommend for men and women in their 50's and older. RLE can help with vision loss (presbyopia) caused by aging and for patients with severe farsightedness. RLE is the same exact procedure as cataract surgery – same preop, same procedure, and same IOLs.



The only difference is who pays for the procedure. Alberta Health Services pay for cataract surgery because the vision is significantly compromised even with glasses. However, AHS typically does not pay for RLE, because, like LASIK, they argue that the patients can just wear glasses or contact lenses. On the other hand cataract surgery is performed on patients who have vision complaints as a result of the clouding of the natural lens, RLE is performed on patients who want to reduce the need for glasses. Cataracts are universal and eventually, we all need cataract surgery. The average age for cataract surgery for patients in the Canada is in their 60-70s. RLE essentially just speeds up the biological clock so that cataract surgery will not be needed later in life.

RLE is an advanced treatment that gently eliminates the original lens on the eye and exchanges it with an intraocular lens (IOL). The new lens allows light to go through the eye and focuses correctly on the retina for better and clearer vision. Our ophthalmologists have extensive experience performing RLE, and they proudly provide several IOLs types, such as multifocal, to meet your unique goals and concerns.

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Best Candidates for RLE

Refractive lens exchange is often suggested to patients who have serious issues with farsightedness or presbyopia. For patients who want LASIK or PRK but do not qualify for the surgeries, refractive lens exchange is an excellent treatment choice. Although we can use RLE to treat nearsightedness, we prefer other less invasive procedures, such as LASIK. RLE may also reduce the possibility of developing a cataract because we take out the damaged lens and exchange it with a new healthy lens.

RLE Procedure

All RLE are done in the same CPSA approved outpatient surgery as our cataract surgeries.  These procedures are done under topical (eye drop) anesthesia.  Before we start your procedure, we will numb your eye with specialized eye drops and provide a mild sedative to help you remain comfortable throughout the surgery. Next, one of our expert ophthalmologists will make a small incision near the side of your cornea and then insert a pen-shaped ultrasound device to break apart the damaged lens. Finally, we will exchange it for an intraocular lens (IOL), which may include options with monovision, multifocal, and/or toric IOL's. Because the incision is tiny, the eye will naturally heal on its own, and you will not need sutures. RLE is an outpatient treatment and patients can resume normal activities almost immediately and drive the next day. Following your procedure, you should experience optimal results in about two to six weeks.

Cataract Lens Options

The type of lens that will be chosen for you depends on the information we obtain during your diagnostic exams and your comprehensive eye evaluation. Below, you will find descriptions and explanations of some of our most popular premium lens options. Our goal is to help educate each patient so that the correct decision is made prior to surgery. Every patient has different visual needs and desires. The key question that needs to be answered is how important is it to the patient to reduce the need for distance glasses?  Secondly, how important is it to the patient to reduce the need for reading glasses in addition to distance glasses?

Symfony-Extended Depth-of-Focus IOLs

One of the most popular intraocular lenses (IOLs) that we offer is the Tecnis Symfony lens by Johnson and Johnson Vision (formerly American Medical Optics and then Abbot Medical Optics). The Tecnis Symfony IOL is an extended-depth-of-focus lens that is capable of correcting near and distance vision in patients both with and without astigmatism.



The Tecnis Symfony lens is not a multifocal lens. A multifocal lens works by splitting light into separate distinct focal points on the retina. Your brain then learns to use the appropriate focal point depending on your activity. In contrast, the Tecnis Symfony IOL transmits light over a range of distances creating an elongated focus, hence the term, extended depth of focus. Patients who elect the Tecnis Symfony IOL need to understand that they may require some reading glasses for prolonged close work or reading smaller print. However, patients who spend a lot of time using iPhones, iPads and other electronic devices enjoy the vision provided by the Symfony lens. The added benefit of this lens is that it is available in Toric and Non toric varieties making it accessible to all eye shapes and sizes.


The lens provides excellent distance and intermediate vision with an improved level of near vision but it does not replace glasses for prolonged or fine close work. Golfers and tennis players are especially good candidates for the extended depth of focus lens because they don’t want to lose track of the ball as it travels. In our experience, patients who elect the Symfony lens find that the neuroadaptation process continues for at least the first three months. As a result, our patients are often happier three months out from surgery than their first week or two!


Many patients ask about cost. Many things in medicine are often not covered by insurance such as specialized hearing aids and dental implants and such is the case with premium intraocular lenses such as the Tecnis Symfony IOL. However, with added cost comes added value! In particular, patients will have a fuller range of high-quality vision and will be able to wear glasses less often after premium IOL surgery. You are making a choice for the rest of your life that impacts you on a daily basis. So, if you spread the cost out over the rest of your life, what is that worth from a value perspective?

Eyhance

Technis Eyhance is a new type of IOL that is made by Johnson and Johnson Vision (formerly American Medical Optics and then Abbot Medical Optics). This exciting new technology uses an optical principle of spherical aberration in order to provide better intermediate vision than standard monofocal IOLs. This means than the lens is designed to have a continuous power differential between the center and periphery of the lens. The effect is excellent intermediate and distance vision with the best near vision located approximately 66 centimeters.


At the present time this lens is only available in non toric varieties, but there are plans to have this lens available in a toric in the near future.


Many patients ask about cost. Many things in medicine are often not covered by insurance such as specialized hearing aids and dental implants and such is the case with premium intraocular lenses such as the Eyhance IOLs. However, with added cost comes added value and this lens is of exceptional value for the cost.

Technis Synergy Lens

This is the most advanced lens on the market today, made by Johnson and Johnson Vision (formerly American Medical Optics and then Abbot Medical Optics). The Synergy Extended Depth of focus lens design allows for superior near vision and exceptional distance vision.


The Tecnis Synergy is not a multifocal lens. A multifocal lens works by splitting light into separate distinct focal points on the retina. Your brain then learns to use the appropriate focal point depending on your activity. In contrast, the Tecnis Synergy IOL transmits light over a range of distances creating an elongated focus, hence the term, extended depth of focus. Patients who elect the Tecnis Synergy IOL are not dependent on glasses after surgery. With a focal point as close as 33 cm patients can even read small print after surgery. Currently the synergy lens is only available to patients without astigmatism, but this should be an addition that is available in a short time.


Many patients ask about cost. Many things in medicine are often not covered by insurance such as specialized hearing aids and dental implants and such is the case with premium intraocular lenses such as the Tecnis Synergy IOL. This lens is simply the best available, so if you do not want to spare anything but the best this is the choice for you.

Follow-Up After RLE

If you need surgery for both eyes, each eye is performed at separate appointments, which we schedule a week apart. Before releasing you, our team will provide in-depth, post-operative directions to ensure your eye heals correctly. After your surgery, you should have someone drive you home. However, many men and women may start driving again after about a week. Typically, patients tend to experience mild symptoms after their treatment, although, these are normal and should subside after a few days. Additionally, you may experience fuzzy vision, halos, or glares, but these side effects will continue to improve over time. We will schedule follow-up appointments so we can continue to monitor your healing. If you have questions in between your visits, please do not hesitate to call our office.

Long-Term Clear Vision

Refractive lens exchange can offer substantial improvement to your eyesight and can help diminish your need for prescription glasses or contacts. For patients 40 and older who struggle with seeing or constantly needing to wear glasses, please schedule an appointment at our office. We provide comprehensive eye exams to determine if RLE is a good treatment option for your condition. We look forward to helping you live a better quality of life.

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