Refractive lens surgery, (also called clear lens exchange or lens exchange) is very similar to cataract removal surgery – one of the most commonly performed procedures in the UK according to clinical data. It removes the natural crystalline lens in the eye with a clear artificial intraocular lens (IOL) and can help improve your eyesight, often eliminating the need to wear glasses or contact lenses
What is refractive lens replacement?
Recent advances in the safety and predictability of micro-incision cataract surgery mean that we are now able to offer this surgery to patients who have minimal or no cataract symptoms but would like to reduce their need for spectacles.
During this procedure the natural lens of the eye is replaced with an artificial intraocular lens, the power of which can be adjusted on an individual basis to dramatically reduce spectacle dependence.
Surgery is particularly effective in those over 50 years who already wear glasses/contact lenses, to correct distance vision, and now find they need to use reading glasses as well. Glasses and contact lens use can obviously be highly inconvenient and does not always have the effect of producing a clear image. Refractive lens exchange offers the option of improved visual quality without the need for glasses or contact lenses.
What is involved in refractive lens exchange?
New techniques allow incision size to be decreased to less than 2mm. These small incisions seal themselves immediately after surgery, without stitches, and normal daily activities can be resumed soon after surgery. A further advantage of no-stitch incisions is that they do not cause a secondary focusing problem known as astigmatism.
After the incision has been made a round opening is created in the lens capsule. A phacoemulsification probe is then inserted, breaking the lens into tiny pieces which are sucked out of the eye. Phacoemulsification uses high-speed ultrasound waves, vibrating 40,000 times per second. Ultrasound phacoemulsification is quicker and safer than laser to remove the natural lens.
A lens implant is then placed in the lens capsule to replace the natural lens and return focusing function to the eye. The latest preoperative measuring and surgical techniques allow 90-95% of people to be independent of distance spectacles directly following refractive lens exchange. It is also possible to insert multifocal lenses helping to correct for the need for reading spectacles.
Our consultant will be able to advise you on the latest developments in intraocular lens technology and which models are most appropriate, on an individual basis.
How long will surgery take?
Lens surgery is a painless experience and the vast majority of operations are now done as a day case procedure. Two kinds of anaesthesia are used - topical anaaesthesia and regional anaesthesia.
Topical anaesthesia is very popular with many people because no needles are required. Instead, painless drops are used to numb the eye. No eye patch is needed and patients usually notice improved vision after 24 hours. This technique can result in a quicker recovery with fewer side effects and is completely pain free. The eye is fully anaesthetised but otherwise you are awake during the procedure, which takes about 15 minutes.
The alternative procedure involves a Sub-Tenon’s anaesthesia where a local anaesthetic is injected into the tissues around the eye. The eye is patched for the rest of the day and patients usually notice improved vision after 24-48 hours.
Local anaesthesia also avoids the post-operative hangover from a general anaesthetic in patients with, for example, chest problems.
The operation is usually performed as a day case, shortening the time in hospital and reducing expense for the patient.
General anaesthesia is still available for patients who prefer to be completely asleep. Many patients worry that they will see what is happening during the operation but all that is usually noticed is a bright light and vague shapes. Although you have to lie fairly still, there is no need to be rigidly immobile - being alert means a patient can adjust their position or even cough or sneeze, provided some warning is given.
Risks and complications of refractive lens surgery?
Many advances in recent years have made the operation safer and improved the visual performance of the new lens. However, you should be aware that there is a small risk of complications, either during or after the operation. Complications are usually treatable, possibly requiring further surgery. In a few cases serious problems such as infection or retinal detachment occur, which may result in visual loss. A continuous audit programme is run to reduce these risks and results are consistently better than national benchmark data.
One of the commonest problems following lens surgery is the development of posterior capsule opacification, as a reaction to the presence of the lens implant. This can result in blurred vision but is easily treated as an outpatient procedure using a YAG laser.
Benefits of refractive lens surgery include:
Note: Eye measurement and lens technology are continuously improving and the vast majority of patients find that they no longer require glasses or contact lenses for the majority of activities. However, it is impossible to guarantee that no glasses or contact lenses will be required after the procedure, but around 90-95% of patients achieve spectacle independence following surgery. If one of the gentle multifocal lenses are used then this usually enables around 90% of activities to be carried out without reading spectacles, with occasional use of glasses for smaller print and/or dim light situations.
Our consultants are very happy to discuss the procedure with you. Don't hesitate to contact our Ophthalmology department to find out more.
The procedure will take up to 30 minutes and is carried out after you have had anaesthetic eye drops to numb the eye surface. Your surgeon will replace the faulty lens with a new one.
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You will have a formal consultation with a healthcare professional. During this time you will be able to explain your medical history, symptoms and raise any concerns that you might have.
We will also discuss with you whether any further diagnostic tests, such as scans or blood tests, are needed. Any additional costs will be discussed before further tests are carried out.
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Our dedicated team will also give you tailored advice to follow in the run up to your visit.
We understand that undergoing eye surgery might cause you anxiety and worry. Our experienced and caring clinical staff will be there with you every step of the way. As well as delivering excellent care and treatment, they’ll answer your questions and provide reassurance if you’re worried at any stage.
The procedure is nearly identical to cataract removal surgery, except that instead of extracting the cloudy lens caused by cataracts, it extracts a clear one.
You'll be given two sets of eye drops before your treatment begins. The first will dilate or widen your pupils. This makes it easier for the surgeon to see the lens in your eye. The second will provide a local anaesthetic to your eye, ensuring the outer surface is numb. In some cases, the surgeon will inject a local anaesthetic around the eye instead.
You may be aware of light and movement while you are being treated but will not feel any pain. This is normal and to be expected.
Once the anaesthetic has taken effect, your surgeon will make a tiny incision on the cornea and use an ultrasound probe to break up the lens. The fragments are removed with a fine tube and a new lens is inserted. The procedure takes 20-30 minutes.
You will usually be able to go home on the same day as your treatment: however you'll need someone to accompany you as your vision will be impaired. Your eye will be covered with a protective pad and shield at the end of your treatment. You're likely to need them for at least a day and your surgeon might advise you to keep the shield on at night for a week or two. This is to prevent you rubbing or pushing your eye when you are asleep.
Your eye may ache for 10 to 14 days. It will also itch or feel sticky for a few days. We will also give you drops to use for the next four weeks to help the eye heal and prevent infection. Your nurse will show you how to put these in and give you advice about caring for your eye. You may find it helpful to wear sunglasses or a hat when you leave the hospital as your eye may be sensitive to the sunlight.
Before leaving hospital we may give you a date for a follow-up appointment with your surgeon. Try not to touch or rub your eye. You will have blurred vision for a few days. As long as you don't mind blurry vision while your eye adjusts to its new lens or you have glasses fitted, you can read and watch television almost immediately. How soon you can return to work depends on the nature of the job. Many people are back at work after a few days but if your job involves strenuous activities or potential exposure to liquid or dust that could get in your eye you may need a few weeks off. The Driver and Vehicle Licensing Agency (DVLA) cautions that you must be able to read a number plate 20 metres away with both eyes open. Up to 90% of people who have surgery for cataracts will eventually have a good enough level of vision to start driving again. Your surgeon will give you advice about when you can resume driving if you have no other eye condition.
You should be enjoying a much clearer view of the world as soon as the side- effects clear 10-14 days after your operation. Depending on the sight in your other eye you might need some help for a few days with routine tasks such as shopping and you won't be able to drive.
Refractive lens exchange is one of the most commonly performed operations and is generally safe. However as with all operations, it carries risks. On rare occasions, complications can occur after eye lens surgery. If you experience any of these symptoms - severe pain, have loss of vision or increasing redness of the eye, you should contact the hospital for advice. Don’t hesitate to call us. Your consultant will talk to you about the possible risks and complications of having this procedure and how they apply to you.
If you have any questions or concerns about your recovery, we're here to help.
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The treatment described on this page may be adapted to meet your individual needs, so it's important to follow your healthcare professional's advice and raise any questions that you may have with them.
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