Refractive Lens Exchange

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Refractive Lens Exchange
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How the eye works

• Light rays enter the eye through the clear
  cornea, pupil and lens.
• These light rays are focused directly onto the
  retina, the light-sensitive tissue lining the
  back of the eye.
• The retina converts light rays into impulses,
  sent through the optic nerve to your brain, where
  they are recognized as images.
• 70 of the eye's focusing power comes from the
  cornea and 30 from the lens.

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Refractive errors

• Inability to see clearly is often caused by
  refractive error.
• Four types of refractive error
• Myopia (nearsightedness)
• Hyperopia (farsightedness)
• Astigmatism
• Presbyopia

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Refractive errors myopia

• In myopia (nearsightedness), there is too much
  optical power in the eye
• The distance between the cornea and the retina
  may be too long or the power of the cornea and
  the lens may be too strong.
• Light rays focus in front of the retina instead
  of on it.
• Close objects will look clear, but distant
  objects will appear blurred.

Myopia, or nearsightedness
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Refractive errors hyperopia

• In hyperopia (farsightedness), there is too
  little optical power.
• The distance between the cornea and the retina
  may be too short.
• Light rays are focused behind the retina instead
  of on it.
• In adults (but not children), distant objects
  will look clear, but close objects will appear
  blurred.

Hyperopia, or farsightedness
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Refractive errors astigmatism

• In astigmatism, the cornea is curved
  unevenlyshaped more like a football than a
  basketball.
• Light passing through the uneven cornea is
  focused in two or more locations.
• Distant and close objects may appear blurry.

Astigmatism occurs when light passes through
football-shaped cornea and/or lens
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Refractive errors presbyopia

• Presbyopia is an age-related condition in which
  your eyes gradually lose the ability to see
  things up close, because the lens of the aging
  eye can no longer change shape.
• When we are young, the lens in our eyes is
  flexible and is able to change focus easily
  between near and far objects, like an autofocus
  on a camera.
• At around age 40, this flexibility begins to
  gradually decrease, making it more difficult to
  see objects up close, unless the eye has
  nearsightedness.

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What is refractive surgery?

• A group of outpatient surgical procedures used to
  alter how your eye focuses light rays on the
  retina, thereby improving vision and reducing
  dependence on glasses and contact lenses.
• In most cases, refractive surgery affects the
  shape of your cornea to redirect how light is
  focused onto the retina. Popular procedures
  include LASIK, LASEK, PRK and CK.

Refractive surgery procedure on the cornea
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What is refractive surgery?

• Most refractive surgery is performed on the
  cornea and affects only the front of your eye,
  while the rest of your eye will change naturally
  as you age.
• In some cases, refractive surgery procedures
  dont reshape the cornea instead, the eyes
  natural lens is either replaced or enhanced by an
  implantable lens that helps correct vision.

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What is Refractive Lens Exchange (RLE)?

• A non-laser procedure where the natural,
  non-cataractous, lens of the eye is removed and
  replaced with an artificial, intraocular lens
  (IOL).
• The cornea is not reshaped.
• Used to treat moderate to high degrees of
  nearsightedness (myopia), farsightedness
  (hyperopia) and patients who are not LASIK
  candidates.

Typical intraocular lenses (IOLs) used in the
refractive lens exchange (RLE) procedure
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How is the RLE procedure performed?

• The IOL is implanted in a surgical procedure and
  performed on an outpatient basis under local or
  topical anesthesia.
• Procedure takes approximately 15-20 minutes.
• RLE procedure is exactly the same as routine
  cataract surgery.

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How is the RLE procedure performed?

• In addition to a complete pre-operative eye exam,
  these measurements are performed to give the
  surgeon the necessary information to calculate
  the necessary power of the IOL
• Keratometry measurement of the form and
  curvature of the cornea.
• Retinal exam.
• The axial length of the eye from the cornea to
  the retina (A-scan).
• The depth of the anterior chamber.

A phoropter is used to measure refractive errors
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How is the RLE procedure performed?

• After the eye is numbed with topical or local
  anesthesia, one to three small incisions are made
  close to the edge of the cornea.
• After the procedure, these incisions are usually
  self-sealing, requiring no stitches.

A small incision is made close to the edge of the
cornea, prior to removing the natural lens and
inserting the IOL
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How is the RLE procedure performed?

• A tiny, high-frequency ultrasound instrument is
  inserted into the eye to break up center of the
  eyes natural, crystalline lens.
• The lens is then gently vacuumed out through this
  same instrument.

The eyes natural lens is suctioned out through
an incision
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How is the RLE procedure performed?

• An IOL is folded and inserted through the same
  incision that was made to extract the natural
  lens.
• The IOL is then unfolded and placed into the
  "capsular bag" that originally surrounded the
  natural lens.

IOL in the eye
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Considerations for the RLE procedure

• May be recommended for patients who have
  cataracts starting to form.
• May be recommended for patients with thin corneas
  who are otherwise not candidates for the LASIK
  procedure.
• May be recommended for patients with unusually
  high refractive error.

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Considerations against the RLE procedure

• Patients with significant ocular disease of any
  type.
• Patients with a history of retinal detachment.
• Patients with any reason for increased risk of
  infection.

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Risks and possible side effects of RLE surgery

• Over-correction or under-correction (with a
  possible need for a re-treatment).
• Infection.
• Increased floaters or retinal detachment.
• Dislocation of implant.

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Is refractive surgery right for you?

• Advanced surgical procedures, including
  refractive lens exchange, are creating more
  opportunities for people who want to be less
  dependent on glasses or contacts.
• Surgery may not entirely eliminate your need for
  corrective lenses. Glasses/contacts may still be
  needed for activities such as fine or detailed
  work, reading and perhaps night driving.

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Is refractive surgery right for you?

• A large part of the success of any refractive
  surgery depends on your understanding of the
  procedure and your expectations.
• Since refractive surgery is an elective
  procedure, you have the opportunity and
  responsibility to become fully informed about its
  risks and benefits.
• Your ophthalmologist will explain the specific
  technique, its benefits, as well as possible
  risks and side effects associated with your case.

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Discuss options and questions with your
ophthalmologist

• With the help of your ophthalmologist, its
  ultimately your responsibility to weigh the risks
  and side effects of a procedure with the benefits
  it has to offer.
• If you decide refractive surgery is right for
  you, you may join millions of people who have
  reduced their dependence on glasses or contacts.