Refractive Lens Exchange

Who Benefits Most?

• People with extreme degrees of nearsightedness or farsightedness, beyond what is easily corrected with laser corrective options
• People with signs of early cataract development
• Most people over 60 years of age who are dependent on corrective lenses for distance vision

Specific Advantages of Refractive Lens Exchange

• Correction for most ranges of nearsightedness and farsightedness
• Predictable outcome
• Fast visual stabilization
• Minimal side effects
• Can be combined with laser or incision corrective options to correct astigmatism
• Eliminates the need for cataract surgery in the future
• Long history of successful outcomes

Unlike laser corrective surgeries which alter the shape of the cornea, a refractive lensectomy changes the focusing power of the lens within the eye. For this procedure, the eye’s natural lens is removed and replaced by a manufactured lens implant which has been selected to provide clear focusing ability. The lens implant remains within the eye, without needing any further care after surgery. It provides a wide range of focusing freedom, but since it is a fixed focus lens, glasses are necessary for all near vision activities such as reading.

A refractive lensectomy is not generally recommended for people under 45, unless the diagnosis and careful testing reveals it to be the best option. People under 45 still have significant flexibility in their natural lens which allows them to vary their focus naturally. This ability is lost in a lens exchange procedure. Since people over 50–55 have already lost much of the flexibility in their natural lens, a refractive lensectomy will not cause much further loss of natural focusing flexibility.

A refractive lens exchange is a simple outpatient procedure. Patients sit in a surgical chair, which is reclined back into a horizontal position. Attentive assistants ensure that patients are very comfortable as they drape them with sterile sheets in preparation for surgery.

Patients are sedated with oral or intravenous medications, if necessary. Only the selected eye is "frozen" for this painless surgery. In most cases, topical drops are used to anesthetize the eye, so no injection is necessary.

A refractive lens exchange procedure is similar to modern cataract surgery. To begin, the surgeon makes a small incision of 1/8 of an inch (2.8 mm) in either the white sclera or on the edge of the cornea. The surgeon inserts a delicate instrument to create a smooth, round opening in the outer capsule of the natural lens. Using an ultrasonic suction probe, the surgeon proceeds to gently break up and suction out the gel from the lens capsule. Then, the surgeon inserts a high quality lens implant of appropriate power and positions it securely within the natural lens capsule. Gimbel Eye Centre surgeons generally use foldable lens implants which are inserted through tiny incisions and then open up inside the eye where they are positioned to provide clear vision. For extremely high corrections, foldable lenses are not manufactured, so the incision is enlarged for the placement of a more rigid lens implant. The surgery is usually completed without stitches, since the incision is designed to be self-sealing. The whole procedure takes around 15 minutes.

Some lens implants can correct astigmatism. If needed, other surgical procedures can be combined with lens implantation to solve astigmatism focusing problems.

Surgeons at Gimbel Eye Centre have performed more than 50,000 lens exchange procedures, primarily for people with cataracts, but increasingly for people without cataracts who just want better vision without corrective lenses.

Visual recovery from a refractive lens exchange, in most cases, is fast and dramatic. A few minutes after the surgery, patients are usually able to see well enough to engage in regular activities with increased visual freedom.

Side effects are minimal. Most patients experience some temporary blurring for a few days from tear film variations or some fluid in the cornea. Patients can also expect increased light sensitivity for a few weeks, so sunglasses need to be worn more often than usual during this time.

The lens capsule closes around the new lens implant in the weeks following surgery, sometimes changing the focusing range to a small degree because of a shift in position. If the stable visual result is not ideal, a second surgical procedure to adjust or replace the lens is possible. An additional laser surgery to improve the focus is also possible.

As with any surgery, there are some possible complications to a refractive lens exchange. However, the risks are minimal. The low incidence of complications listed here reflects the exclusive Gimbel Eye Centre experience:

• Increased Possibility of Retinal Detachment (less than 1%)
  Farsighted people have a very low risk of detachment, however, most nearsighted people have eyes that are longer than normal, resulting in retinas which are more vulnerable to detachments. The risk of retinal problems because of surgery is extremely small. A retinal examination required before the surgery helps to determine the risk factors for each patient. Even if a detachment occurs, it can generally be effectively repaired.
  
  
• Inner Eye Surgery Complications (less than 1%)
  The following complications are very uncommon, but they can occur: hemorrhage or infection within the eye, swelling around the eye, reflections or sight distortions from the lens implant, an increase of floaters, loss of corneal clarity, dislocation of the lens implant, wound leak, glaucoma and uveitis (inflammation). Most of these complications can be effectively treated if they occur.
  
  
• Corneal Surface Surgery Complications (less than 1%)
  The corneal surface problems of induced astigmatism and slightly increased dryness are not generally serious and may be effectively treated.