Refractive Lens Exchange (RLE) – 07
Published on: November 25, 2020



Refractive Lens Exchange (RLE)

Volume 07

“A rose by any other name would smell as sweet.” Thank you Mr. Shakespeare! Speaking of names, “Refractive Lens Exchange” is known by numerous monikers. Let’s see… (1) Clear Lensectomy, (2) Refractive Lensectomy, (3) Clear Lens Exchange… you get the picture. Regardless what you choose to call this procedure, it is another great refractive surgery option, and another tool that we love having in our tool box of refractive procedures.
The easiest way that I have found to communicate what the Refractive Lens Exchange (RLE) procedure is to patients, goes something like this… “It’s cataract surgery without the cataract”. Elegant. Simple. Understandable. A more appropriate description would convey that RLE replaces the natural crystalline lens with an intraocular lens (IOL). Choosing RLE opens up all kinds of potential combinations of IOLs from the most basic monofocal IOLs to the latest and greatest premium IOLs. [Side Note: the PanOptix multifocal IOL has been absolutely amazing – so much so that I am seriously considering having RLE myself and getting bilateral PanOptix lenses… stay tuned.]

Depending on the certain circumstances, RLE might be a better choice:

  1. The medical factors determining candidacy for any particular refractive procedure (prescription, topography, pachymetry, health, etc.) don’t allow for full treatment to be delivered via a corneal procedure (LASIK/PRK).
  2. The expectations for what the respective procedures can deliver. For example, LASIK and PRK cannot deliver clear distance and near vision in each eye if the patient has entered presbyopia, so if a patient expects results that exceed the limitation of the given technology, we view that as an unrealistic expectation, so we then discuss RLE so we can introduce IOL options that can better address their wants/needs/expectations.
  3. What is their ultimate goal of having surgery? We believe in tailor-fitting the procedure to the situation. Sometime RLE just makes more sense compared to every other option.
  4. As an added bonus, if a patient chooses RLE, they will never have to have cataract surgery due to their natural lens having already been removed.

[Note: We do not recommend RLE on pre-presbyopic patients due to the fact that accommodation would be surrendered when the natural lens is removed. Patients over the age of 45 are more ideal.]

Here are just a few of the wide array of IOL choices, depending on the specific needs and wants of each patient:

  • Monofocal IOL
    • Distance OU
    • Monovision: distance (dominant) / near (non-dominant)
  • Aspheric IOL
  • Toric IOL
  • Accommodative IOL
  • Extended Depth of Focus IOL
  • Multifocal IOL

To look at this list of IOL types, you could say that this is the exact list that a cataract patient has to choose from when selecting an IOL based on their specific needs and wants… and you would be exactly right! Again, the main difference between RLE and cataract surgery is the fact that RLE is removing a clear lens, not a cloudy lens.

In closing, when you are referring a patient for a refractive consultation, remember that there are many choices. Here are the most mainstream of them all:

  1. LASIK (laser-assisted in situ keratomileusis)
  2. PRK (photorefractive keratectomy)
  3. ICL (implantable collamer lens)
  4. RLE (refractive lens exchange)

We must all remember that it is our responsibility to assess candidacy, explain the differences between the procedures and then make the appropriate recommendation. Therein lies my specialty. I have been working in the refractive surgery field for the vast majority of my career, so I invite you to get to know me and let’s build a relationship. If you haven’t picked up on it yet, I love to teach, so I welcome all questions! Call me!

Until next time!

George Goodman, OD, FAAO
Director of Cataract and Refractive Services
EyeCare Associates of South Tulsa
10010 E 81st St #100, Tulsa, OK 74133
O: 918.250.2020 | C: 405-245-9333 | F: 918.250.8910

Service-oriented, comprehensive eye care in a timely fashion.
Please send your comments and suggestions to
or call Dr. Goodman at (405) 245-9333 (cell).

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