Presbyopia and Refractive Lens Exchange

Presbyopia is the loss of near vision with age, typically beginning around 40 or 45. It is unknown exactly what causes it, but for some reason your eye loses its ability to change the shape of its lens (known as accommodation, see our page on How the Eyes Work for more information). In the past, the only solution available for presbyopia was reading glasses, bifocals, or trifocals, but now some doctors are recommending a solution known as refractive lens exchange (RLE).

Similar to Cataract Surgery

In RLE, people who are beginning to suffer from presbyopia have their eye’s lens removed and replaced with an intraocular lens (IOL). This is essentially the same procedure as cataract surgery, and it only became an option once advanced technology IOLs were developed for cataract surgery, allowing many people to be completely independent of glasses after surgery.

RLE is also a way that people can prevent cataracts before they begin. Cataracts form in the eye’s natural lens, and once that lens is removed cataracts cannot form. Some people even believe that presbyopia represents an early stage of the changes in the eye’s lenses that lead to cataracts, so it makes sense that the treatment should be related.

IOL Options

There are several different kinds of IOLs available that may be able to give you excellent vision after surgery. The two major types are multifocal IOLs and accommodating IOLs. Multifocal IOLs focus light from objects at several distances onto your retina. When you want to look at one at a particular distance, your brain selects the clearest image of it available. Lenses of this type are:

The only accommodating IOL currently approved by the US Food and Drug Administration (FDA) is Crystalens. Each of these lenses has its strengths and weaknesses. See Which IOL Is Right for Me? to learn about talking to your doctor about making decision about IOLs.

Disadvantages of RLE

The main disadvantage of RLE is that you might not get the vision you desire after surgery. Most people see a tremendous improvement in vision using advanced IOLs over traditional monofocal IOLs in cataract surgery, but how well your results compare to your presbyopic vision is less certain. Many of the IOLs trade off better vision either up close, far away, or both, for intermediate-range vision, which may be a problem for you. All multifocal IOLs create night vision effects (starbursts, halos, glare, etc) to some degree. And a small but significant number of people never adapt to seeing with a multifocal IOL.

Crystalens is demanding on a cataract surgeon, and some may not successfully perform the operation, leading to complications. In addition, Crystalens is sometimes associated with dimming of the visual field similar to cataracts, which may require additional procedures.

These tradeoffs are more significant for RLE patients who are younger and generally have better starting vision than cataract surgery patients, so it is even more important to talk to your doctor about possible disadvantages of the procedure.

To get in contact with an ophthalmologist in you area, please contact us today.