What is Refractive Lens Exchange (RLE)?
Cataract surgery is often performed, before the development of any cataract, with the sole purpose of eliminating or reducing the need for spectacles or contact lenses. This operation is referred to as ‘Refractive Lens Exchange (RLE)’. This type of procedure is commonly used as an alternative to laser eye surgery or other implant techniques in presbyopic patients around the age of 50 years old.
Modern cataract and RLE surgery are a form of keyhole surgery in which the natural lens is removed through a 2 mm incision. High frequency ultrasound energy delivered through a probe is used to liquefy the natural lens which sits within a clear lens capsule or “bag”. This process is called phacoemulsification. The lens material is washed out and an IOL is inserted through the same incision. Once inside the eye, the IOL unfolds within the lens capsule, replaces the natural lens and focuses light accurately on the retina (the light sensitive layer at the back of the eye). The small incision is self-sealing and does not affect the strength of the eye wall.
Mr Maurino has pioneered small incision cataract and RLE surgery with the use of toric, trifocal implants (IOLs) and femtosecond laser. He is an internationally recognised authority in cataract and RLE surgery. Refractive lens exchange and cataract surgery are identical procedures and you can find more information by going to our cataract surgery page.
Your Refractive Lens Exchange (RLE) Premium IOLs choices
Monofocal IOL have a uniform focus and provide excellent image quality but have a limited range of focus. It is very useful to be able to see clearly at a range of distances after surgery, and surgeons using conventional lenses commonly aim for to minimally spread the focus between the two eyes to achieve a greater depth of focus. This strategy is called blended monovision. Typically, for patients with good vision in both eyes, the aim is to achieve a clear focus for one eye in the distance and the other at arm’s length. This helps to minimise spectacle dependence for most activities. However, reading glasses are normally needed for reading , and a distance prescription may be preferred for some activities – especially in low lighting conditions (e.g. theatre, cinema, night driving).
These lens implants are well tolerated and provide enhanced spectacle independence, allowing good unaided vision for both distance, computer and reading. However, whilst premium IOLs produce a greater depth of focus than conventional lenses, there can be a compromise on image quality. Some patients can be troubled by dysphotopsia – light scatter symptoms (e.g. starburst, glare and haloes) and therefore premium IOLs may not be the right choice if you do a lot of night driving. At your consultation, Mr Maurino, who has published extensively in the fields of premium lenses, will be in able to advice you on IOLs choice.
Toric IOLs (for the correction of astigmatism) are used to correct astigmatism on the cornea. Toric IOLs are inserted at a specific position within the eye and are very effective at correcting up to 8 dioptres of astigmatism. Mr Maurino uses Toric IOL routinely and has published extensively on the subject. Best results are achieved in patients with at least 1.5 D of corneal astigmatism.
n special situation Vincenzo Maurino will advice also the IC-8 IOL that uses a pinhole technology to minimise need for spectacles for any distance and help correcting astigmatisms and presbyopia. This technology is best for patients with abnormal corneal shape (after corneal transplants, eye traumas, keratoconus, radial keratotomy and high prescription laser vision correction) to achieve better spectacles independence and minimise the risk of dysphotopsia.
RLE, like cataract surgery a commonly performed surgical procedure. Like any type of surgery, complications can occur but are very rare. The rate of complications is the least with a very experienced and specialist cataract surgeon like Mr Maurino.
- In the absence of other eye problems that may limit vision, most of patients having RLE-cataract surgery will be able to achieve driving standard of vision or better without glasses after treatment. These results are greatly improved by combining state of the art surgical and lens implant technology with great experience and expertise thus significantly increasing the safety and the outcomes of surgery.
- Reading glasses are normally required after surgery, but dependence on spectacles for near vision can be reduced by using premium lenses (trifocals, EDoF or toric).
- Implants should not deteriorate after surgery , in the absence of any new problems in the eye, clear vision should be permanent once recovery from the cataract surgery is complete provided no other pathology appear later in life. However, some implants may become opaque in time and need changing. This is rare and can be dealt with in the unlikely event it does happen.
- The most common reason for visual deterioration after RLE-cataract surgery is a frosting-over of the tissue surrounding the IOL, known as posterior capsular opacification (PCO or Secondary Cataract). This is treated by a quick and effective YAG laser capsulotomy procedure in the office. Whilst PCO is not uncommon , it can be sorted by a quick in office laser procedure lasting 2 minutes.
- Although very rare, RLE-cataract surgery can result in visual loss. Complications that can cause serious visual loss after RLE-cataract surgery include infection, spontaneous rupture of sub-retinal blood vessels during surgery (choroidal haemorrhage), or untreatable retinal detachment. Such complications are extremely rare; it is important to be aware that you should immediately attend our Casualty Department at Moorfields (open 24/7) for an emergency eye examination if you experience either a progressive increase in pain or sudden loss of sight after RLE-cataract surgery.
- Sight-threatening complications such as retinal detachment or infection can often be treated successfully if they are caught at an early stage. Any patients experiencing sudden onset or worsening of flatters, flashing lights and shadow in the vision must be seen by an eye surgeon immediately.
- Approximately 1 in 100 patients will require a second operation to correct problems resulting from RLE-cataract surgery. In the vast majority of these patients, the final visual outcome is good, but visual recovery may be delayed.
- Approximately 1 in 100 patients will require a laser procedure to further reduce spectacle dependence (such as for instance Femto LASIK or No Touch LASEK) if desirable.
- Approximately 1 in 50 patients can experience sudden onset of floaters after RLE-cataract surgery. This can happen naturally with age and more commonly in patients with short sight. Floaters are usually well tolerated, and the brain is able to ignore them, but you must be aware of this possibility. Also, if you experience a sudden onset of flashing lights, floaters or any similar symptoms, you should be examined immediately to exclude a retinal involvement, which could cause a detached retina.
- Dysphotopsia: It is common after cataract and RLE surgery to become aware of some unawanted visual side effect. Dysphotopsia is awareness of glare, halos and starburst especially at night when driving and in artificial light. Can happen with any type of implants and usually is temporary and improves with time. It is more common with premium presbyopia correcting implants (multifocal/trifocals/EDoF and similar) due to the more sophisticated optical design needed to achieve less spectacles dependence. Mr Maurino will explain in details the risks and management of dysphotopsia at the time of consultation. Having performed premium lens implants surgery in hundreds of cases and published studies on premium IOL technology, he is in a unique position to advise you and help to choose the best implant for you.
Private RLE surgery
The main advantage of private RLE surgery is that you will have your eye surgery performed by a consultant eye surgeon of your choice, giving you the reassurance that your eyes are in experienced hands. This will ensure the best possible outcome and that your surgery is carried out with the lowest possible risk.
Private RLE surgery also gives patients a greater choice in terms of access to the latest, cutting-edge technology. Patients have a wide choice in lens technology including the possibility of having a toric lens to eliminate astigmatism or a trifocal/multifocal lens to give greater independence from glasses for both distance, computer and near vision. Combining advanced lens removal technology with the latest lens implant choices (trifocals/multifocal and toric) increases the chances of eliminating the need for glasses and leading an active life<
Choosing Vincenzo Maurino at Moorfields
Vincenzo Maurino is a Senior Consultant Ophthalmic Surgeon at Moorfields Eye Hospital NHS Foundation Trust and the Director of the Cataract Surgical Service at Moorfields. Mr Maurino’s principal areas of expertise include small incision phacoemulsification lens surgery performed with or without femtosecond laser and trifocal and toric IOL implants. Vincenzo Maurino has great experience of presbyopia correcting IOL surgery and has lead several studies on multifocal IOL. Mr Maurino has published scientific papers on cataract surgery and advanced lenses implants and having performed circa 30,000 cataract/RLE procedures, he will be able to advise on the best options to suit your specific needs.
The only way to discover which of our procedures is appropriate for you is to come to one of our clinics, Moorfields Eye Hospital Private or the London Claremont Clinic, for a consultation. Lasting around 1½ hour, our team will perform a series of comprehensive eye tests, some of which will be familiar to you, and some of which are specific to the assessment process for cataract surgery and RLE.
We think it’s important that all of our patients have the chance to meet their surgeon at the consultation, not just on the day of treatment. Mr Maurino will fully examine your eyes and go through the results of your eye tests with you. He will then advise you as to the most appropriate treatment for you. This gives you a chance to ask questions so that you have all the information you need to make the decision to go ahead or not. It’s entirely up to you – there’s never any pressure from us.g Vincenzo