Vision Correction and Lens Replacement Surgery
What is Lens Replacement Surgery?
Lens replacement surgery is known as refractive lens exchange (RLE) and is a common procedure involving replacing the natural lens with a synthetic one, known as an intraocular lens or implant.
Lens replacement surgery can be used for both the treatment of cataracts and also to improve refractive issues, such as presbyopia, short-sightedness, long-sightedness and astigmatism. The clarity and flexibility of lenses lessen with age and many older patients who would like their sight corrected actually have the beginnings of a cataract. The operation for refractive lens exchange for refractive error and for cataract is exactly the same.
Do I need to have cataracts or glaucoma to benefit from lens replacement surgery?
No, if you’d like to reduce your dependence on glasses or contact lenses then lens replacement could be an option. The procedure is often carried out on those who would otherwise be rejected for laser surgery.
What type of lenses can mine be replaced with?
There are two types of artificial lenses that can replace your own:
Monofocal – these will improve your sight at a distance, but you will still need glasses or contact lenses for near tasks.
Multifocal – these are designed to correct both distance, mid-range and near vision.
At present, the NHS only offers a monofocal lens, meaning that you choose between having near or distance vision. If you choose to go private, you will be able to choose either a monofocal lens or a multifocal lens.
How well do multifocal intraocular lenses work?
You can find information on the National Institute of Clinical Excellence (NICE) website or within the Refractive Lens Exchange Patient Guidance from the Royal College of Ophthalmologists.
In my own audit of lens replacement surgery, I have found that only 5-7% of patients require glasses after the procedure.
How do I choose which lenses to have?
Your surgeon will help you to choose which lenses are best for you and also what is available via the NHS or private treatment.
If you choose multifocal lenses, I use Rayner, Alcon and Johnson and Johnson multifocal lenses, which are clinically proven and have a very high success rate.
Can I have a monofocal lens and change to a multifocal at a later date?
Generally, your surgeon will only remove a monofocal lens if there is a clinical reason. This is because the procedure can cause damage to the eye and therefore should only be carried out if necessary.
There is an option to add a multifocal lens on top of a monofocal one, although this is not suitable for every patient. If you would like further information about this option, please contact me to discuss.
Can I have the lenses replaced in both eyes at the same time?
If you need to replace the lenses in both eyes, you will need two operations. These are usually carried out 1 to 2 weeks apart, in order to give the first eye time to heal and for your vision to return.
Will my eyesight be perfect after RLE (refractive lens exchange)?
I always say that RLE will give you “your best vision”, that means the best vision that your eyes are capable of seeing. Everyone is different and therefore everyone’s eyes are different. During your consultation, we will discuss the outcome that you are looking for and the likelihood of achieving that.
The lowest level of success that we aim to achieve is that after surgery your eyes can see as well as they could with glasses or contact lenses.
What happens during lens replacement surgery?
The surgery is carried out under local anesthetic and is relatively quick, lasting only 30-45 minutes.
The surgeon will make a very small cut in your eye to remove your natural lens and replace it with the artificial implant. You will need to rest for up to an hour immediately afterwards but can go home the same day.
Your eye may be covered with a pad and shield over the eye, but this can be removed the next day. The eye will feel numb initially but feeling should return after a few hours.
As with cataract surgery, the following side effects are very normal and should go away in a few days.
- Watering.
- Blurred or double vision.
- Red/Bloodshot eye.
- A ‘gritty’ feeling.
If you need to order new glasses, you will have to wait until your eye is fully recovered to ensure the prescription is correct.
After the recovery period, you should be able to return to all normal activities.
Are there any side effects or complications of this surgery?
Side effects or complications are minimal and rare. Many patients experience some blurring and light sensitivity for up to a few weeks, and depending on the lens used, you may suffer haloes around lights or glare, especially at night. As with any surgery, there is always the risk of infection, pain, a reaction to the anaesthetic or blood clots forming. Your surgeon will discuss these with you, prior to surgery.
If you experience any of the following side effects, you should contact your eye surgery department as soon as possible:
- Decreased vision.
- Increased pain and/or redness.
- Increased discharge or stickiness.
What can I do, or not do after my surgery?
In order to aid recovery and ensure the best outcome, it is important to ask your surgeon’s advice on aftercare.
You should allow at least 48 hours before returning to work or normal activities, although some patients need up to a week to adjust to their new eyesight. You will have regular appointments with your surgeon to assess your healing and advise any additional care.
Your surgeon will prescribe eye drops to be used as directed, and you will be advised to keep your eye dry, especially when showering and washing your hair. If you suffer any discomfort, over-the-counter painkillers can be used. Whilst you can start most normal activities as soon as you feel able, you will be advised to avoid swimming, strenuous exercise and driving until your surgeon has given the go ahead.
Depending on your work situation and the circumstances involved with your surgery, your surgeon will advise when you can return to work.
If you have poor vision in your other eye also, it may be a good idea to have someone take care of you until the vision in your treated eye improves.
More information:
https://www.nice.org.uk/guidance/ipg264/informationforpublic
Please contact me if you are considering lens replacement surgery and would like to know more.