Refractive Lens Replacement (RLE)
Refractive lens replacement involves removing the patient’s natural lens and implanting an artificial intraocular lens in its place . The RLE procedure differs from the classic cataract surgery only in that it is performed on patients with a translucent lens or opacities that are irrelevant to vision.
What are lens-based refractive treatments ?
Refractive Lens Replacement (RLE) is a surgical method that allows you to correct large refractive errors (myopia, hyperopia with or without astigmatism). This procedure consists in removing the patient’s own lens and implanting an artificial intraocular lens implant into the preserved lens capsule, with the power selected so that the patient does not have to use glasses after the procedure.
Until recently, this method only corrected distant vision, which was a problem in young patients under 40. After the age of 40, patients begin to experience problems with presbyopia ( presbyopia ) associated with the deterioration of vision of objects from close distances (reading, writing, etc.). With age, our lens thickens, hardened and loses elasticity, and thus cannot change shape, which means we lose the ability to sharpen the image at various distances – loss of accommodation. Initially, we deal with moving small objects farther and farther away from our eyes to see them more clearly, and finally people who have had good eyesight so far have to use near glasses. Presbyopia cannot be cured. You can help by giving glasses, contact lenses or by operating the eye. The removal of the lens in patients over 45, with presbyopia, with complete or partial lack of accommodation, is less severe than in younger patients, because they are used to using an additional pair of glasses at close range. In recent years, there has been a dynamic development of companies producing implants and new technologies in the search for the perfect implant. An artificial implant requires compromises. It has a different effect than a self lens. The implant is supposed to simulate its operation, but also does not have the accommodation of a young, healthy eye.
A few years ago, biomedical engineers developed new lenses that imitate accommodation (multifocal lenses, lenses with extended focal length) enabling sharp vision at various distances. This significantly reduces the patient’s dependence on glasses and can help anyone who is disturbed by reading glasses and working in close proximity to the eyes. This procedure is especially recommended for patients who do not qualify for laser refractive surgery procedures, have cataracts and a major defect, and want to become independent from glasses.
At present, it is the best method to correct the refractive error and at the same time to remove the presbyopia. Over 90 percent patients after the procedure do not use glasses at all – neither for distance, nor for near. For each patient, we try to individually adjust the lens implanted during the surgery, taking into account the lifestyle, previous eye defect, additional eye diseases, the patient’s needs, habits, type of work, hobbies and expectations.
We make the decision together after a comprehensive examination of your eyes. The starting point is the patient’s visual needs. It depends on them, among others selection of the model, type of material and design of the lens. Intraocular lens implant selection >>
What are the indications for the procedure?
This treatment is recommended for patients who do not want or tolerate wearing glasses and contact lenses. The main goal of refractive lens replacement procedures is to improve the quality of vision. Patients are eligible for refractive lens replacement surgery without cataracts or with baseline changes that do not yet have significant visual impairment. These treatments make it possible to correct large refractive errors. Due to the fact that lenticular procedures do not touch the cornea, they are the refractive procedures of choice for patients who additionally have corneal problems such as: thin corneas, dry eye, corneal ectasia.
How to prepare for the procedure?
Before the operation, very precise eye examinations are performed on technologically advanced, state-of-the-art devices: IOL Master 700 biometric examinations (measurement of the length of the eyeball, corneal curvature, depth of the anterior chamber, corneal thickness, WTW), topographic eye examination (Oculyser), aberration measurements (and Trace) and astigmatism testing (Verion). On this basis, after an extended optometric and ophthalmic examination, a joint decision on the type of surgery will be made.
Then there is a visit to an individual caretaker-medical consultant who will help you safely and stress-free go through the entire medical procedure. About a week before the surgery, there is a visit to the anesthesiologist who will assess the general state of health and suggest a type of anesthesia for the procedure. If the health condition deteriorates before the procedure, the consultant should be informed about your malaise, as it may be necessary to postpone the procedure. As with all intraocular procedures, good health and no eye inflammation are essential.
Hard contact lenses must not be worn for 3 weeks prior to the procedure. Soft contact lenses should be avoided for 1 week before the procedure. Make-up should not be applied to the face and eyes on the day of the procedure. Take an accompanying person with you or ask someone to pick you up from the clinic as you will not be able to drive on your own. You should eat regular meals the day before surgery, unless your doctor asks for a longer break.
After the procedure, you cannot do eye makeup for 1 month. False eyelashes are not recommended as they hinder eye hygiene. You can make henna of eyelashes and eyebrows a week before the procedure. It is recommended to take leave from work or leave. Avoid physical exertion for 1 month.
How is the procedure going?
The procedures are performed in the operating room, under local anesthesia, drip anesthesia, from a small incision, under the conditions of one-day surgery, do not require hospital stay. They are similar to the typical cataract removal by phacoemulsification. Treatments are painless and an anesthesiologist is present. They do not require long rehabilitation, give excellent results, patients are satisfied with the course and the results achieved.
Will I need another surgery?
You have to be aware of the fact that refractive surgery is not always a single procedure, but in some cases a process and sometimes additional strengthening treatments are needed to achieve the desired effect. Implant measurements are based on statistical calculations, so a residual vision defect may remain, especially in eyes with an unusual structure. Residual vision impairment may also be caused by the individual eye healing process, scar formation and the resulting effective lens position in the eye, which cannot be predicted prior to surgery.
If the expected effect of the surgery is not achieved, an additional procedure may be added, e.g. replacing the intraocular lens with a different one of a different strength, adding a second lens or correcting the residual defect using a laser technique (BiOptics technique). The refractive lens replacement is designed to make the patient independent of the glasses. After each implantation of the lens, it is likely that the glasses will be used in special situations requiring intense visual work, but not on a daily basis.
Multifocal lenses are designed so that they perform best after binocular implantation. The effects of the surgery improve significantly after the lens is implanted in the other eye. It is best to perform the treatment on both eyes at the same time. Second eye surgery can also be performed shortly after the first eye. The best results are obtained after binocular surgery. Approximately 1 month should elapse between operations on both eyes. The period of adaptation and getting used to the new way of seeing usually lasts from 1 to 3 months.
What are the post-treatment recommendations?
After the procedure, the patient receives precise instructions on what to do and what to avoid. Immediately after the procedure, it is recommended to use eye drops for about 1 month. Avoid physical exertion, dirty, dusty rooms, contact with chemicals and people with inflammation of the eyes. The eye undergoing surgery should be monitored for life. The aging eye is at risk of developing additional ophthalmic diseases, and lens surgery does not inhibit their progress. Once healed, the eye should undergo ophthalmological check-ups at least annually, provided that there are no other additional ophthalmic conditions requiring monitoring. In the case of other diseases, checks must be more frequent – their cyclicality is determined individually.
An additional benefit of replacing the lens is that it allows the clinician to accurately examine the back of the eye, which is especially important when there are initial opacities in an aging lens, and to avoid surgery when an advanced cataract develops.
What is the risk of non-operation?
Failure to operate results in a further need for glasses or contact lenses. You should take into account the discomforts associated with the aging process of the eye lens that occur after the age of 40. Due to the aging processes of the eye, the lens loses its transparency and elasticity, turns yellow, becomes cloudy, its shape changes and its thickness increases. There is a loss of contrast, a decrease in visual acuity, weakening of spatial vision and visual adaptation, and higher-order aberrations. The changes are often accompanied by the need to use stronger and stronger long distance glasses and additional glasses for close distances and intermediate distances, e.g. when working at a computer.
The precision of diagnostic tests of diseases located in the back part of the eye deteriorates with age. It may therefore be difficult or impossible to diagnose diseases more common in the aging eye (retinal diseases – AMD, diabetic retinopathy and optic nerve diseases – glaucoma). A significantly opaque lens in which a cataract develops requires surgery. In an eye with advanced cataracts, it is more difficult to precisely select an implant and the risk of surgical complications increases.
Do you have questions or doubts? Book an appointment for a free consultation with an operations expert.
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