Presbyopic Lens Exchange (PRELEX)

PRELEX, or presbyopic lens exchange, is a surgical procedure that reduces the need to rely on glasses for near and/or distance vision. It replaces the natural lens of the eye with a synthetic multifocal lens.

This procedure can be done alone or combined with cataract surgery. It is typically used to correct vision in patients who are over 45 years old.

What Is PRELEX Used For?

Presbyopic lens exchange is a popular surgery that helps patients see more clearly while minimizing dependence on corrective eyewear. It is a type of refractive lens exchange (RLE) that can restore normal vision via a multifocal synthetic lens.

PRELEX is designed to help people who are experiencing presbyopia, a condition in which the eye’s lens does not focus on near objects. As presbyopia is caused by natural aging, there is no way to reverse the condition

PRELEX is most often performed for people who are coping with age-related vision changes. PRELEX helps patients who want corrections for near-distance and/or far-distance vision.

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How Does PRELEX Work?

PRELEX replaces the natural lens of the eye with a multifocal lens. A multifocal lens works similarly to bifocal glasses, allowing you to see both up close and far away clearly.

When you have a multifocal lens implanted in your eye, you must adjust to this new visual system. It takes some time to adapt to the new way of seeing things.

Visual Cortical Adaptation

The human brain perceives and responds to sensory input. This input is influenced by what the brain has seen in the past, known as visual cortical adaptation.

When the natural lens of the eye is replaced, it may take some time for the brain to adapt to what it is perceiving with this new visual system.

For instance, if you’ve used monofocal glasses to correct vision, you will be accustomed to seeing near objects as blurry and distant objects as clear. With new multifocal lenses, objects will appear clear, whether they are close, medium distance, or far away. It can take some time to get used to the new visual experience.

Typically, it takes the brain time to adjust, but there isn’t a set amount of time for the adjustment period. The timeline varies for each person. It may take weeks or months to adjust to this new way of seeing, but expect improvements over time. 

Advantages of PRELEX

With any refractive lens exchange procedure, patients can enjoy visual acuity without relying on glasses or contacts. For many individuals, this is a chance to live an active lifestyle, read comfortably, and continue doing work that requires close vision.

Refractive lens exchange provides good visual outcomes for a range of refractive errors.

PRELEX offers specific advantages to patients, including these:

• Correction for most types of farsightedness, including presbyopia 
• Few side effects
• Fast recovery timeline
• Can correct astigmatism when combined with other procedures

About Presbyopic Lens Exchange 

PRELEX is usually done as outpatient surgery, with one eye treated per procedure. During the surgery, the eye is numbed with anesthesia, so you will not feel pain.

The surgeon will gently make a tiny incision and remove the natural lens of the eye. Using the same incision, the multifocal lens will be inserted into your eye. Typically, the incision seals itself, and natural eye pressure holds it in place.

In some cases, surgeons will reduce pre-existing astigmatism with micro incisions. These are called limbal relaxing incisions (LRIs).

After the surgery, you’ll go home to rest and relax. Most people find that their vision improves almost immediately, and they can resume their daily activities in a couple of days.

Postsurgical Recovery

After surgery, expect to spend some time adjusting to your new vision. Many patients find that it takes two to three months to fully adjust.

If you’ve been wearing glasses, you may notice that distance vision is almost immediately better. It may take longer to adjust to the clarity of your near vision. 

For some patients, there is no adjustment time.

Risks & Complications of PRELEX

The main risks associated with PRELEX are patient satisfaction, endophthalmitis, retinal detachment, and surgical problems.

Patient satisfaction is closely tied with expectations and individual goals. If patients are highly motivated to reduce dependence on glasses or enjoy a glasses-free lifestyle, the rewards of this surgery are high. 

Endophthalmitis is an infection of the eye and a potential risk of surgery. Every surgical clinic tracks rates of endophthalmitis occurrence. 

The risk of retinal detachment depends on the eye’s axial length as well as surgical operating procedures. 

Talk with your surgeon, so you are fully aware of potential risks or complications with your procedure. 

Who Is a Candidate?

The best candidates for this procedure are people who are unhappy with their vision. This includes patients who don’t see well with glasses. 

PRELEX is a good choice for people who meet the following criteria:

• Want freedom from glasses or contacts
• Want to reduce dependence on glasses or contacts
• Experience cloudiness on their natural eye lens
• Want to correct nearsightedness and/or farsightedness
• Want to prevent or remove cataracts
• Desire an active lifestyle, without reliance on glasses
• Are open to change

According to Ocular Surgery News, people who have an adaptable personality are most suited to benefit from this surgery. This enables them to adapt to the vision changes with PRELEX.

PRELEX Costs

PRELEX generally costs several thousand per eye. The cost varies depending on the region of the country, surgical fees, and clinic variations. PRELEX prices typically include evaluation, anesthesia, surgical fees, postoperative care, and clinic fees.
Some surgeons offer a comprehensive package, including fees for secondary surgeries if these are performed within a specific time limit. Check with your surgeon to fully understand what is included in the costs.

PRELEX is generally not covered by insurance. Multifocal IOLs are usually not covered by insurance, though monofocal IOLs may be covered.

References

1. What Is Presbyopia? (February 2022). American Academy of Ophthalmology (AAO).

2. Presbyopic Lens Exchange (PRELEX) Cataract Surgery Outcomes With Implantation of a Rotationally Asymmetric Refractive Multifocal Intraocular Lens: Femtosecond Laser-Assisted Versus Manual Phacoemulsification. (December 2019). International Ophthalmology.

3. What Is Astigmatism? Symptoms, Causes, Diagnosis, Treatment. (February 2022). American Academy of Ophthalmology (AAO).

4. Aging Eyes: Vision Changes & Common Problems. (November 2020). Cleveland Clinic.

5. Adult Vision: 41 to 60 Years of Age. American Optometric Association (AOA).

6. Adaptation in the Visual Cortex: A Case for Probing Neuronal Populations With Natural Stimuli. (July 2017). F1000 Research.

7. Presbyopic Correction Today. (2008). Hong Kong Journal of Ophthalmology.

8. PRELEX Surgery Reduces Need for Spectacles, Surgeons Say. (February 2002). Ocular Surgery News (OSN).

9. Think PRELEX for Ultimate Patient Satisfaction (September 2001). Ophthalmology Management.

10. Patient Satisfaction and Halo Perception Following Presbyopic Lens Exchange (PRELEX) in Younger, Non-Cataractous Eyes. (May 2007). Investigative Ophthalmology & Visual Science.

11. PRELEX Questions and Answers. (December 2002). WFSA 12 News.