Refractive Lens Exchange (RLE) and PRELEX

Refractive Lens Exchange (RLE), also known as clear lens extraction, is a surgical procedure that involves removing the eye's natural lens and replacing it with an artificial intraocular lens (IOL). This surgery is primarily designed for individuals with high refractive errors, such as severe myopia, hyperopia, or presbyopia, who may not be suitable candidates for laser vision correction procedures like LASIK/ SMILE and ICL/ Phakic IOL procedures.

Presbyopic Lens Exchange (PRELEX) is a specialized form of RLE aimed specifically at correcting presbyopia. Similar to RLE, PRELEX involves removing the natural lens and replacing it with a multifocal or accommodating IOL, allowing patients to achieve clear vision at all distances. By replacing the natural lens with a multifocal or EDOF IOL, patients can achieve clear vision at multiple distances.

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"RLE is particularly beneficial for patients over 40 years old, who often experience presbyopia (difficulty focusing on near objects).It is particularly suitable for patients who want to reduce their dependence on reading glasses and enhance their quality of life."

RLE offers several advantages:

  • Eliminates Dependence on Glasses: By replacing the natural lens, patients can reduce or eliminate their reliance on glasses or contact lenses for vision correction.
  • Presbyopia Correction: For those over 40, RLE can effectively correct presbyopia, allowing for improved near vision without reading glasses.
  • Personalized Solutions: Various IOL options are available, including multifocal, trifocal, and accommodating lenses, which can be customized based on individual visual needs.
  • Improved Visual Outcomes: Patients often experience significant improvements in visual acuity and quality of life post-surgery.

The RLE procedure typically involves the following steps:

Step 1: Preoperative Assessment

A comprehensive eye examination is conducted using the Pentacam and IOL Master 700 to evaluate the eye’s structure and determine the appropriate IOL type.

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Step 2: Surgery

Under topical/ local anesthesia, a small incision is made in the cornea. The Alcon Centurion Phaco Machine is then used to gently break up and remove the natural lens through a process called phacoemulsification. The artificial IOL is then implanted in its place.

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Step 3: Recovery

The entire procedure usually takes less than 15 minutes per eye. Patients can expect a quick recovery, with many experiencing improved vision within a few days.

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Post-operative care is crucial for a successful recovery. After RLE surgery:

  • Follow-Up Visits: Patients will need to attend follow-up appointments to monitor healing and visual outcomes.
  • Eye Drops: Prescribed eye drops will help prevent infection and reduce inflammation.
  • Activity Restrictions: Patients are advised to avoid strenuous activities, swimming, and rubbing the eyes for a few weeks post-surgery.
  • Visual Adjustment: It may take time for vision to stabilize as the brain adjusts to the new lens.

Choosing the right IOL is crucial for achieving the best post-surgery vision. We offer a range of premium IOLs to meet the diverse needs of our patients. Below are the main types of IOLs we provide:

Multifocal IOLs

Purpose: Multifocal IOLs are designed to correct both near and distant vision. This lens has multiple focal points, allowing patients to see clearly at varying distances without relying on glasses.

Advantages
  • Reduces dependence on reading glasses or bifocals after surgery.
  • Patients experience clearer vision for tasks like reading, using mobile devices, and driving.
  • Suitable for those who wish to minimize the need for corrective eyewear.
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Trifocal IOLs

Purpose: Trifocal IOLs are the latest advancement in lens technology, offering vision correction at three distinct ranges: near, intermediate, and far distances. This makes trifocal lenses ideal for individuals who lead active lifestyles and need good vision at all distances.

Advantages
  • Provides seamless vision from close-up tasks (like reading) to mid-range activities (like working on a computer) and far-range vision (like driving).
  • Better performance in low-light conditions, improving night vision.
  • Great for individuals who need to perform a variety of activities without constantly switching between glasses.
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EDOF (Extended Depth of Focus) Lenses

Purpose: EDOF lenses are a more recent innovation, designed to provide a continuous range of vision, especially for intermediate distances. They create a “stretched” focal point, offering better vision for tasks like using computers, tablets, or reading at arm’s length.

Advantages
  • Ideal for patients who spend a lot of time using digital devices.
  • Reduces glare and halos compared to multifocal lenses, making it a good option for those sensitive to bright lights or who frequently drive at night.
  • Enhanced depth of field provides sharper vision across a broader range, making it an excellent choice for an active lifestyle.

Ideal for: Patients looking for a smooth, continuous range of vision and reduced visual disturbances like glare and halos, especially those with an active lifestyle

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Toric IOLs

Purpose: Toric IOLs are specially designed to correct astigmatism in addition to the cataract. Astigmatism occurs when the cornea has an irregular shape, leading to blurred or distorted vision. Standard IOLs do not address this issue, but toric IOLs have different powers in different parts of the lens to correct the uneven curvature.

Advantages
  • Corrects astigmatism and improves distance vision at the same time.
  • Reduces or eliminates the need for glasses or contact lenses to correct astigmatism after cataract surgery.
  • Suitable for patients with significant astigmatism who want sharper vision and less dependence on corrective eyewear.

Ideal for: Individuals with moderate to severe astigmatism who wish to correct both cataracts and astigmatism in one procedure.

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Aspheric IOLs

Purpose: Aspheric IOLs are designed to mimic the natural shape of the human lens. Standard IOLs have a spherical shape, which can cause minor optical aberrations. Aspheric lenses, however, are shaped more like a natural lens, which allows for better light focusing and improves contrast sensitivity.

Advantages
  • Provides sharper and clearer vision, especially in low-light conditions such as nighttime driving.
  • Reduces glare and halos that can be caused by traditional spherical IOLs.
  • More closely mimics the optical performance of the eye's natural lens, delivering higher-quality vision.

Ideal for: Patients who want enhanced visual clarity, especially in situations like driving at night, or those who prioritize sharpness and reduced optical aberrations.

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RLE may be suitable for individuals who meet the following criteria:

  • Over 40 years of age and experiencing presbyopia.
  • Have high refractive errors (myopia, hyperopia) that cannot be corrected with glasses or contact lenses.
  • Have cataracts or a high risk of developing cataracts in the future.
  • Seek to reduce or eliminate their dependence on glasses or contact lenses.

A thorough evaluation by our experienced ophthalmologists will help determine if RLE is the right choice for you.

As with any surgical procedure, RLE carries some risks, including:

  • Infection: Although rare, infections can occur following surgery.
  • Visual Disturbances: Some patients may experience halos, glare, or other visual disturbances, particularly at night.
  • Need for Glasses: While RLE can significantly reduce dependence on glasses, some patients may still require them for certain tasks.
  • Retinal Detachment/ Bleeding: There is a small risk of retinal detachment or bleeding in the eye especially in high myopes.

Our team will discuss these risks in detail during your consultation, ensuring you have a clear understanding of what to expect.

Our eye care centre is equipped with the latest diagnostic and surgical technology to ensure the highest level of precision and safety during RLE procedures. Key technologies include:

Oculus Pentacam – Gold Standard Tomography

The Oculus Pentacam is an advanced diagnostic device that provides comprehensive imaging of the cornea and anterior segment, crucial for pre-surgical evaluations and post-operative monitoring. The device is first of its kind to be capable of detailing posterior corneal surface amking it gold standard for decision making in laser refractive procedure.

Advantages

  • Detailed Corneal Analysis: Measures corneal thickness, curvature, and elevation to detect abnormalities like keratoconus or irregular astigmatism.
  • 3D Anterior Segment Imaging: Offers a complete view of the eye's front structures, aiding in customized treatment planning.
  • Safety Screening: Helps identify patients who may not be suitable candidates for refractive surgery, ensuring safe and effective outcomes.
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Zeiss IOL Master 700 – Precision Optical Biometry

The Zeiss IOL Master 700 is the gold standard in optical biometry. It provides extremely accurate measurements of the eye, which are critical for selecting the right intraocular lens (IOL) and used for all lens based refractive surgery procedures including ICL and RLE/ PRELEX. The machine uses swept-source OCT (Optical Coherence Tomography) to map the entire length of the eye, ensuring optimal lens positioning and power calculation.

Advantages

  • Enhanced precision in preoperative measurements and IOL selection reduces the risk of post-operative refractive errors, ensuring better visual outcomes.
  • It provides a full-length scan of the eye, which helps detect any issues early, allowing for a more customized surgical plan.
  • Suitable for complex cases, such as eyes with high astigmatism or previous surgeries like LASIK.
  • Best data capturing power for accuracy even in advanced cataracts

Alcon Centurion Gold Phacoemulsification System with Active Sentry

This is one of the most advanced cataract surgery phacoemulsification system available especially useful with lens bared refractive surgery procedures systems available.

Advantages

  • Active Fluidics: This feature maintains stable intraocular pressure (IOP) throughout the surgery, reducing the risk of complications and making the procedure safer for patients.
  • Efficiency: The Centurion system uses advanced energy management to emulsify and remove the lens more efficiently, minimizing trauma to the eye and shortening recovery time.
  • Real-Time Pressure Monitoring: Active Sentry provides real-time feedback and adjustments during surgery, ensuring smoother and more precise operations.
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Why Mahajan Eye Centre?

Expertise and Experience

Our experienced surgeons have been performing Refractive Len Exchange (RLE) surgeries for decades, ensuring high success rates and patient satisfaction.

Advanced Technology

Our investment in latest technology (Zeiss IOL Master 700, Oculus Pentacam, Alcon Centurion Phaco System) enables us to provide safer, precise, and efficient surgeries.

Personalized Care

We customize every aspect of your RLE surgery, from pre-surgical measurements to selecting the IOL that best suits your lifestyle and vision needs.

Comprehensive Post-Op Care

Our team will guide you through a smooth recovery process, ensuring that any post-surgery issues are promptly addressed as needed.

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Frequently Asked Questions

The RLE procedure typically takes about 20-30 minutes per eye.
Most patients experience little to no pain during the procedure due to local anesthesia. Mild discomfort may occur during the recovery phase.
Depending on the patient's visual needs, various types of IOLs can be used, including monofocal, multifocal, trifocal, and accommodating lenses.
Most patients can resume light activities within a day or two but should avoid strenuous exercise for at least a week.
RLE is typically recommended for patients over 40, but age alone is not the sole factor; a thorough eye examination is necessary to determine candidacy.
Many patients experience significantly improved vision and may not need glasses for most activities, but some might still require them for specific tasks.
Patients should follow the pre-operative instructions provided by their surgeon, including any recommendations regarding medications, contact lenses, and lifestyle changes.
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