Refractive Lens Exchange Center


Our natural lens inside the eye has the ability to flex and focus at different distances, but unfortunately this flexibility begins to fade away around age 42. “Dysfunctional Lens Syndrome” describes this loss of focus due to the hardening of the natural lens. This forces patients to wear reading glasses for near tasks such as reading, viewing the cell phone, and working on the computer. This can be very frustrating, but fortunately technology has evolved to keep up with our everyday needs. With today’s advanced lens procedures, patients can have a multifocal lens or extended depth of field (EDOF) lens to reduce their dependence on glasses. These intraocular lenses (IOL) can be implanted at the time of cataract surgery. They can also be implanted before a cataract develops fully; this procedure is called a Refractive Lens Exchange (RLE).

The Light Adjustable Lens

Light Adjustable Lens

The Light Adjustable Lens (LAL) was approved by the FDA in 2017 and is the only intraocular lens available whose power can be adjusted after cataract surgery.  Despite the many formulas that are available to help your surgeon choose the right power of intraocular lens during cataract surgery, there are factors related to healing and final lens resting position that are outside of a surgeon’s control.  Now with the LAL we can adjust the lens power three weeks after healing has completed to achieve the best possible vision for our patients without glasses.  This allows patients to trial and adjust their vision to their own personal needs.

How does the LAL work?

The LAL contains macromers which are UV light adjustable molecules.  The molecules can be adjusted with a special UV light apparatus in the office after surgery to correct astigmatism, nearsightedness and hyperopia.  Therefore, after surgery the patient can have their vision fine tuned for distance and/or reading.  Many patients choose to have both eyes set for distance but others choose to have their dominant eye set for distance and their non-dominant eye set for computer reading.  In addition, the lens can be adjusted more than once so patients have the opportunity to “Test drive” their vision before the final locking in of the lens is done at approximately six weeks after surgery.  Once the lens is “locked in” it cannot have further adjustments.

It is important to limit UV light exposure after your surgery until the LAL lens is “locked in.”  UV protection glasses are provided and prescribed to be worn after surgery to protect your LAL lens until it can be adjusted and “locked in” by your surgeon.  The LAL does have an ActiveShield protective layer that was developed to protect the LAL from an accidental uncontrolled UV light exposure such as a patient walking outdoors without wearing sunglasses the first week after surgery.  Rest assured that with this built-in ActiveShield a brief exposure to UV light will not cause your LAL lens to be altered in a negative way.

What are the risks or disadvantages of the LAL?

There is no additional risk to cataract surgery from using the LAL lens.  The procedure is no more complex when the LAL lens is used and the LAL lens does not cause the haloes or starbursts that can be induced from multifocal lenses.

Multifocal Lens

A multifocal lens is designed to provide clear vision in the distance and near. Multifocal lenses include the PanOptix Trifocal (Alcon), Tecnis Multifocal (J&J), and ReSTOR Multifocal (Alcon). Multifocal lenses have been used extensively over the past ten years. These lenses provide freedom from glasses for over 90% of patients who have them in both eyes. The lenses have multiple rings of focus and provide an increased range of vision compared with monofocal lenses, although it is common to see halos at nighttime around bright light sources like headlights. Patients often notice halos but these improve over time through a process called neuroadaptation as the brain learns to ignore the halos. This continues to improve over the first 6 to 12 months after surgery.

PanOptix Trifocal IOL

Our surgeons are comfortable implanting all the available multifocal lenses but have increasingly been using the newest multifocal, the PanOptix Trifocal IOL. This lens provides better intermediate vision than other multifocal lenses without compromising the distance and near vision. The previous generation of multifocals provided the sharpest vision at two focal points, distance and near. Many patients who had these lenses still needed to use computer glasses. The PanOptix Trifocal IOL offers an additional third focal point to provide sharp vision at intermediate range, in addition to the distance and near. Many of us need sharper intermediate vision not only for computer and tablet use but also for other activities like grocery shopping. We expect our patients that have this lens to see clearly in the distance, intermediate, and near.

Vivity Extended Depth of Field (EDOF) IOL

Vivity device

The Vivity EDOF IOL is a lens designed to provide functional high-quality vision from far distance to about 26 inches to minimize the use of glasses. This lens is designed to provide clear vision for driving as well as the use of the computer and tablets. There are some night time artifacts that decrease over time through the process of neuroadaption. This lens is better for patients who want sharp distance and computer vision and do not mind using reading glasses for near work. Also, patients who are not candidates for a multifocal lens may still be a candidate for the Vivity IOL.

Are there other lenses that can improve near vision?

Monofocal lenses can be adjusted to provide monovision where the dominant eye is set for the distance and the other eye is set for near. Many patients already use monovision with contact lenses. If they have already adjusted to monovision, cataract surgery or refractive lens exchange can be performed to duplicate the same monovision they enjoy with contact lenses. There can be some loss of depth perception with monovision, so it may not be a good option for everyone. We always encourage patients to try monovision first with contact lenses before having monovision surgery to make sure it is the best choice for them.

Will I need the procedure again? How long does it last?

The intraocular lens is designed to last a lifetime and the lens should not become cloudy or change position. The lens typically does not need to be replaced except in only very rare circumstances. In addition, the eye does not typically change in refraction significantly after an intraocular lens has been placed. The main reason for a refraction change is a worsening cataract (the clouding of our natural lens), which is removed with a refractive lens procedure. Some patients may develop a clouding or film behind the lens implant, which typically can be cleared with an in-office YAG laser procedure. This should return the vision to how it was immediately following the lens implant procedure.

Is Refractive Lens Exchange Painful?

The procedure is done as an outpatient at our surgery center with topical anesthesia (eye drops). There should be no eye pain during the surgery and the procedure itself lasts 15 minutes. There are no sutures placed and the eye does not need to be patched. Recovery is quick and most patients resume their normal activities within 1-2 days following the procedure.

How do I pick the right surgeon?

It is important to realize the Refractive Lens Exchange is not typically performed by a surgeon who specializes in only LASIK and in fact, it may not be mentioned during a consultation with a LASIK specialist. After age 50 it is very common to have the beginnings of a cataract and therefore Refractive lens Exchange often provides clearer and more long-lasting vision than LASIK, especially for far sighted individuals. Drs. Beers and Liu have extensive experience with LASIK as well as with lens implant procedures. In fact, they have taught the residents at Stanford University the latest techniques in lens implant procedures. We also perform all of our own post-operative care to make sure your recovery goes as smooth as possible.

How can I find out if I am a candidate for Refractive Lens Exchange?

Many patients over age 45 have complaints of their vision “not being as clear as it used to be” with some glare and halos at night. These are the symptoms of an early cataract that can be improved with Refractive Lens Exchange. If you are having some of these symptoms, you may be a good candidate for Refractive Lens Exchange. We encourage patients to come in for a complimentary consultation that includes corneal mapping and a retinal scan to help determine if you are a good candidate for Refractive Lens Exchange. Drs. Liu and Beers will discuss your lens options that would best match your lifestyle.

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