Refractive lens exchange or RLE is essentially a cataract surgery but used exclusively for correction of refractive errors, most especially in people over 50 years old.

Ageing brings along many changes that include psychological, physiological, social, and physical changes. This natural biological process causes internal and external bodily changes: muscles shrink, bones become brittle, major organs may function less efficiently, nerves degenerate, senses start to weaken, skin becomes less elastic, hair becomes finer, and even the eyes weaken.

A common eye problem is presbyopia or difficulty reading small print or seeing objects upfront. This is why many people over forty start wearing reading glasses to minimise eye strain during reading or doing very close work.

Another common eye change that develops with age is cataracts. A cataract is a clouding of the lens in the eye causing blurred vision. Other visual problems may include fuzzy vision, double vision, sensitivity to glare, difficulty seeing at night, loss of colour intensity, seeing halos around lights, and even frequent changes in eyeglass prescriptions. It can occur in one or both eyes although it cannot spread from one eye to the other.

In normal vision, light passes through the lens to the retina. It is in the retina where light that enters the eye is changed to nerve signals that are interpreted as images by the brain. If the lens is cloudy because of a cataract, then the images seen are blurred. With age, the lens becomes less flexible and less transparent. The lens is mostly made up of proteins and water. Clouding of the lens happens because of changes in these proteins and lens fibres. With time, a cataract will eventually interfere greatly with vision.

Middle-aged people often have subtle signs of cataracts that can cloud the lens progressively. Cataracts do not actually cause harm to the eyes but can interfere with normal daily activities like driving, watching television, doing needlework, or reading. Having cataracts can also be pretty dangerous because vision can become so blurred and hazy that people can be at greater risk of having falls or injuries.

The treatment for a cataract is by surgical removal. The eye doctor will have to replace the clouded lens. The replacement lens is placed in the same place as the natural lens and will work just like a real one.

For people with refractive errors along with the beginnings of cataract development, a refractive lens exchange is an ideal procedure to go through.

In RLE, the lens of the eye is replaced with a new and permanent lens implant. The replacement silicone or plastic intraocular lens (IOL) has the power to correct nearly all, if not all, vision problems caused by longsightedness or shortsightedness.

RLE is also known by alternative names like Clear Lens Exchange (CLE), Clear Lens Extraction (CLE), and Refractive Lens Replacement (RLR). It is an alternative to LASIK, PRK, LASEK, and epi-LASIK laser procedures because sometimes, the degree of refractive errors is too high to be effectively corrected by laser eye surgery.

In addition to remaining cataract-free, the treatment has several advantages over other forms of refractive surgery. In refractive lens exchange, the corneal tissue is virtually untouched. Therefore, this procedure is especially useful for those with thin corneas and dry eyes.

This relatively quick and painless procedure can be done easily and only requires about 20 minutes per eye to be completed. A mild sedative or an anaesthetic gel can be given for more comfort. The method is consistent and reliable, having been done safely using the same technique for decades.

After the surgery, it will take about a week for vision to be clear enough and it will continue to improve in the next month or so. During this period, eye drops help moisten the eyes and reduce the risk for infection.

RLE can permanently correct either or both myopia (shortsightedness) and hyperopia (farsightedness or long-sightedness). If cataracts are already starting to form, choosing refractive lens exchange is best. The artificial lens implant is a permanent replacement for the clouded natural lenses and will last a lifetime. In addition to correcting the focusing power of the eyes, the new implanted lenses will never develop cataracts, eliminating the need for possible cataract surgery in the future.

For a successful refractive lens exchange, it is highly recommended to see a highly qualified eye doctor since not all surgeons can perform RLE and the procedure might not be offered in every laser clinic.