Refractive Lens Exchange (RLE)

Refractive lens exchange (RLE) is a procedure in which the natural lens of the eye is broken down, suctioned out, and then replaced with a synthetic lens that corrects your vision.

RLE is a common alternative to LASIK, with its own use cases, advantages, and disadvantages. One of its bigger disadvantages is its premium price point.

What Is a Refractive Lens Exchange?

Refractive lens exchange (RLE) is a form of refractive surgery in which the natural lens of an eye is taken out and replaced with an artificial lens. 

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IOLs & Available Options

One of the main components of RLE is the intraocular lens (IOL) inserted into the eye. There are three main IOL types.

Monofocal

A monofocal lens has one point of focus, helping to correct a person’s vision so they can see far, intermediate, or near. Unlike a natural lens, IOLs don’t adjust, meaning a person may need corrective eyewear to see distances other than the distance level their IOL is designed for.

Monofocal lenses are the most common and cheapest kind of IOLs.

Multifocal

Multifocal lenses differ from monofocal lenses in that they focus on multiple levels of distance. The brain slowly adjusts to this different way of seeing, and these lenses may allow you to forgo needing corrective eyewear to either read or see long distances.

The downside is these lenses are associated with trouble seeing in low-light conditions. They may also reduce your depth perception.

Toric

Toric lenses differ from the other two options in that they are specifically designed to correct astigmatism. Because of how they work to correct asymmetrical vision, they can also blur your vision if even slightly misaligned. 

What Is the Purpose of RLE?

An RLE procedure is intended to replace your eye’s defective lens, which is causing a refractive error, with a synthetic lens that helps light better focus on your retina and produce a clearer image. These are common refractive errors that can be corrected with RLE:

• Hyperopia (farsightedness)
• Myopia (nearsightedness)
• Astigmatism

Benefits of RLE

Refractive lens exchange can help you see without corrective eyewear. 

While you may still need reading glasses, depending on the specifics of the lens you get inserted, this can free you from having to remember corrective eyewear all the time. It can allow you to perform some activities, such as driving, without additional accessories. 

RLE Candidates

There is some debate over the best candidates for RLE procedures. 

Some doctors believe high myopes, patients with a high level of nearsightedness, are not good candidates due to a higher risk of retinal detachment. Regardless, several respected commissions have called RLE generally applicable for fairly high (+5 to +10) and fairly low (-5 to -25) symmetrical refractive errors.

Those same organizations (The Commission for Refractive Surgery, a joint committee of the German Ophthalmological Society, and the Professional Association of Ophthalmologists in Germany) mark LASIK as a better option for patients with more middling error levels. LASIK is one of the primary alternatives to RLE.

In addition to the noted error levels, the differences between these two procedures mean that candidates who are older or have thin corneas may be good RLE candidates but poor LASIK candidates. 

The RLE Procedure

Eye surgery is generally performed with the patient awake, although the eye will be anesthetized, so the procedure is painless. You may be prescribed medication to help you relax during the procedure. A special tool is used to keep the eye open and prevent it from moving during surgery. 

During RLE, an opening is made at the edge of the cornea. Then, your natural lens is broken down using an ultrasonic tool. The broken-down lens is suctioned out and an artificial lens is put in its place. 

Recovery From Refractive Lens Exchange

While you may experience some discomfort as your eye heals, recovery is typically straightforward. RLE is a short procedure, and you can go home when it is over, although you will need someone else to drive you. Your sight will improve more or less instantly once the lens is in place.

Within a few days, your surgeon should allow you to drive and engage in most activities as normal. It’s recommended you refrain from some activities, such as swimming or contact sports, for longer. 

In the first week or so following surgery, you will likely be prescribed antibiotic and anti-inflammatory eye drops to reduce the risk of complications as you heal.

RLE Risks & Side Effects

One of the bigger risks of RLE is retinal detachment, which can cause permanent vision problems if not addressed. Retinal detachment is usually obvious, with strange shifts in your vision and what may appear as a shifting veil over the affected eye’s sight. 

Most eye surgery also carries an inherent risk of infection, bleeding, and swelling. Your doctor will work to control these risks, and prescribed antibiotic and anti-inflammatory drops will further reduce the risk of complications.

One side effect of an RLE is that eyes with synthetic lenses work differently. Your eye may not adjust the way it used to, and you may still need corrective eyewear to see at certain distances, even when your lens allows you to see normally at other distance levels. 

RLE vs. LASIK

Below is a chart to quickly compare some of the strengths and weaknesses of LASIK vs. RLE:

	LASIK	RLE
Best For	Patients needing a small to moderate level of correction	Patients needing a high level of correctionPatients who cannot get LASIK Older patients
Timing Estimate	About 10–20 minutes per eyeBoth eyes often done at the same appointment	About 15–25 minutes per eyeEyes typically done separately
Recovery	Most activities within 24 hoursHeavy physical activity within 1–3 months, with doctor approval	Comparable to LASIKFast improvement to vision
Main Reasons to Avoid	Thin corneasTearing risk	Retinal detachment riskCost

Refractive Lens Exchange FAQs

Is an RLE painful?

The actual RLE procedure is generally painless. You may experience some minor discomfort during your recovery but serious pain isn’t normal.

For most patients, the most concerning effect during recovery is the potential for blurs or glares in your vision. If you experience these visual distractions a lot or for long periods, let your doctor know to make sure your eye is healing as expected and that the lens is still properly in place.

How long is RLE recovery?

Most activities can be resumed within only a few days, with some more active activities like contact sports taking longer. Always talk to your surgeon about your recovery timeline. They’ll make recommendations regarding when you can resume important activities such as driving or going back to work.

How much does RLE cost?

RLE can cost as much as $4,000 per eye, sometimes more. As a general rule, you can expect it to cost twice as much as a similar LASIK procedure. Insurance is unlikely to cover this cost.

References

1. Basic Knowledge of Refractive Surgery. (February 2008). Deutsches Ärzteblatt International.

2. Dispelling Myths About Refractive Lens Exchange. (September 2020). Ophthalmology Times.

3. Refractive Lens Exchange (RLE) – An Alternative to LASIK. (March 2008). LASIK Surgery News.

4. Refractive Lens Exchange Surgery. St. Joseph’s Hospital.

5. The Refractive Lens Exchange Debate. (June 2005). The American Academy of Ophthalmology.