Refractive Lens Exchange
(Clear Lens Extraction)

By Marilyn Haddrill; contributions and review by
Brian S. Boxer Wachler, MD

In refractive lens exchange (RLE) eye surgery, your eye's natural lens is replaced with an artificial one to achieve sharper focus.

While RLE technically does not have FDA approval, some surgeons in certain circumstances will use the procedure off label.

This type of use is perfectly legal and sometimes a practical option for elective vision correction surgery, particularly for older people and younger people in some circumstances.

Refractive Lens Exchange for Older People

People who are middle-aged or older may have the beginnings of cataracts that eventually could worsen and cloud the eye's natural lens. In time, these cataracts could become advanced enough to require cataract surgery and replacement of the eye's clouded lens with an artificial or intraocular lens.

If you have early cataracts, you could choose to have a refractive lens exchange instead of waiting for the cataracts to advance enough to require cataract surgery. Artificial (intraocular) lenses likely can provide significantly better uncorrected vision at that point, especially if you now require vision correction with glasses or contact lenses.

But keep in mind that you often can receive Medicare or insurance coverage for cataract surgery, which is a necessity, but not for an elective vision correction procedure like RLE. Costs of refractive lens exchange can range from about $2,500 to $4,500 per eye or higher, depending on the type of artificial lens used.

A major appeal of RLE is represented in newer accommodating or multifocal intraocular lenses, traditionally used in cataract surgery, with their ability to restore distance vision as well as improve near vision that enables functions such as computer use and reading for aging eyes. Presbyopia affects all of us beginning at around age 40, when our eye's natural lens grows more rigid and we lose the ability to focus at all distances (accommodation).

The Alcon AcrySof IQ ReSTOR, Abbott Medical Optics ReZoom and Tecnis, and Bausch & Lomb Crystalens are three presbyopia-correcting intraocular lenses with FDA approval.

Refractive Lens Exchange for
Younger People

For extreme farsightedness (hyperopia) higher than +6.00 diopters, LASIK is generally not recommended, making refractive lens exchange a possible option.

If a traditional intraocular lens is used, distance vision can be corrected, but reading glasses would be needed. If an accommodating or multifocal intraocular lens is used, reading glasses may be needed infrequently. [See also: Intraocular lenses or IOLs]

While refractive lens exchange is relatively safe, you do need to consider that any surgery has risks that should be discussed in detail with your eye surgeon.

As an example, the FDA notes that the chances of a retinal detachment are slightly higher in people who have undergone refractive lens exchange, compared with the general population. Otherwise, risks are similar to what people undergoing cataract surgery would face. The procedure for refractive lens exchange also is identical to cataract surgery. [Read more about cataracts and cataract surgery and presbyopia-correcting IOLs .]