All You Need to Know About Refractive Lens Exchange Surgery aka THE Laser Lens Treatment

Refractive Lens Exchange (RLE) or the Laser Lens Treatment (LLT) might be one of the best kept secrets in eye surgery. Of all the treatment options, this is the only one that could be a one time treatment that can correct far vision, near vision, and even astigmatism. In this comprehensive guide will provide you with everything you need to know about the Laser Lens Treatment, its benefits, and how it compares to other vision correction options.

Understanding Refractive Lens Exchange

Refractive Lens Exchange

When lights comes into the eye, the eye uses the cornea and the lens to focus the light onto the retina so that we are able to wake up and see. However, the lens is made of special cells, called epithelial cells, which are sensitive to aging. These cells, found in the hair and skin, are the reason for presbyopia, cataracts, grey hair, and wrinkles. Everyone will get all four of these if they live to be old enough. The first to happen for most patients is presbyopia or age-related blurry near vision. When presbyopia happens, the cells in our lens have become hard. Patients have to start wearing reading glasses, bifocal glasses, or bifocal contacts.

Another option could be LASIK eye surgery. However, LASIK only treats one vision zone, so patients would have to do monovision lasik. This is where one eye is focused for far away and the other is focused for near activities.

Often times patients want to keep their eyes balanced and actually take care of the problem. If presbyopia is happening because the lens is getting hard due to an over growth of these lens cells, then why don't we just treat those cells. We can treat those cells with a laser and then once removed, new lens cells or a lens can replace those cells.

There are many different types of lenses that can be used during this refractive surgery and this is where it is important to really understand how you use your eyes. Let's talk a little more about the laser lens treatment and discuss the refractive lens exchange risks as well.

The RLE Procedure

The RLE procedure is a refractive procedure typically done as outpatient surgery, taking approximately 15 minutes per eye. During the surgery, with assistance from a femtosecond laser, the hardened lens is fragmented and those cells are vacuumed under an operating microscope.

An intraocular lens (IOL) is implanted to replace the natural lens that has been removed. This lens implant extends the range of focusing power of the eye providing clear vision at several distances.

Purpose of RLE

RLE is primarily used to correct:

  • Presbyopia, a naturally occurring age-related condition wherein the eye’s natural lens becomes more firm and inflexible, resulting in a decreased ability to focus on near objects.

  • Moderate-to-severe hyperopia, myopia, or even astigmatism.

  • For some patients, this an alternative for those not suitable for LASIK or PRK.

Another reason patients choose eye lens replacement surgery is they are looking for a one time procedure. Because the Laser Lens Treatment removes the lens cells that are hardened, then cataracts will never happen. So patients

Ideal Candidates for RLE

Candidates for RLE

RLE is ideal for individuals over 40 years old, with early cataracts, nearsightedness, farsightedness, and presbyopia. Those with moderate to high farsightedness, as well as individuals over 45 with farsightedness and presbyopia, may be best suited for RLE.

Unsuitable for LASIK or PRK

Guess what? If you are not a candidate for laser vision correction, RLE is a great option for individuals > 45 years old with with severe refractive errors, thin corneas, or abnormal corneas enabling it to correct a broader range of vision issues.

Individuals who are looking for a more permanent fix to their vision problems choose RLE over laser vision correction because we are eliminating the need for cataract surgery down the road.

Intraocular Lens Options

Intraocular Lens Options

There are different IOL options available for RLE, providing various levels of vision correction. Most patients who are doing the laser lens treatment choose to correct their distance, intermediate, and near vision. However, if there is some underlying ocular pathology, then sometimes we can be limited in the range of vision we can correct. The great news is that we can now correct astigmatism with a monofocal, extended depth of focus, or a trifocal lens.

Trifocal or Multifocal IOLs

Multifocal IOLs provide patients with the greatest range of vision. From being able to see a street sign to reading your computer or phone. The most popular multifocal available right now is the trifocal lens, which corrects far, intermediate, and near vision.

FDA clinical trials for trifocal IOL's resulted in positive feedback from patients. 92 percent of patients reported that they rarely or never need glasses post-surgery. This result supports similar findings in our experience implanting these lenses.

Adequate lighting and understanding of how these lenses work lead to a better outcome and happier patient. In order for these lenses to work, we need to make sure that your eye health is pristine. The consultation is critical in us being able to determine if a trifocal lens will work for your eyes.

Recovery and Post-Operative Care

Recovery and Post-Operative Care

Post-operative care immediately after the surgery and the subsequent long-term recovery constitute the recovery process from an RLE. Patients may experience temporary side effects such as blurred vision, glare, and mild discomfort, but can expect immediate improvement in their baseline vision. In fact, many patients drive in themselves to the 1 day post operative visit. For those who don't feel comfortable, they will see their vision improve day by day.

It is important to avoid sweat, makeup, and water in the eye for the first week. We ask you not to do any strenuous exercise, such as power lifting for one week. Patients if choosing the trifocal lenses, will see halos around the light at night and that will continue to improve over the next to

Comparing RLE to Alternative Vision Correction Procedures

Comparing RLE to Alternative Vision Correction Procedures

Comparisons are often drawn between the laser lens treatment and alternative vision correction procedures like LASIK and cataract surgery. While there are similarities between these procedures, each has its own unique benefits and drawbacks.

Understanding the differences can help you make an informed decision about which vision correction option is best for you.


RLE is an alternative to LASIK for those with multiple refractive errors such as presbyopia and hyperopia or those with unsuitable corneas. Also, LASIK only corrects one vision zone per eye, such as far vision, where RLE can correct two or three vision zones PER eye.

So why do not all patients choose the Laser Lens Treatment? RLE is more expensive than LASIK. Despite these differences, RLE remains the most popular option for individuals > 50 years of age.

RLE vs. Cataract Surgery

RLE shares some similarities with cataract surgery, as both involve removing and replacing the natural lens from the eye. However, the primary difference between RLE and cataract surgery lies in the name and the purpose of the surgery. Cataract surgery is used when the patient has a cataract. RLE or LLT is used when the patient doesn't have a cataract. For example if a patient just has presbyopia but no cataract we would recommend RLE or the Laser Lens Treatment.

As a result, RLE is typically classified as an elective procedure, whereas cataract surgery is deemed medically necessary for individuals with significant vision loss and glare due to a cloudy lens. Understanding the differences between these procedures can help you determine the most suitable option for your vision correction needs. Lastly, if insurance is used, some insurances will not allow both eyes to be done on the same day; whereas, RLE has both eyes done on the same day.

Costs and Insurance Coverage

Costs and Insurance Coverage

In deciding whether to opt for this vision correction method, it’s vital to factor in the cost of RLE and the availability of insurance coverage options. Since this is a one time procedure, RLE is generally more expensive than other eye procedures and is not typically covered by insurance.

Cost of RLE

The cost of RLE varies from $4,000 to $7,000 per eye, depending on the region and the type of implant used. Factors such as surgeon expertise, facility fee, anesthesia fee, and lens cost can influence the cost of RLE.

Financing Options

We try to accept as many financing/payment options as possible, such as Care Credit, Alphaeon, Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs). may be available to help cover the cost of the procedure.

Risks and Complications of RLE

Risks and Complications of RLE

Potential risks and complications are a part of any surgical procedure, including RLE. These may include increased eye pressure, infection, retinal detachment, dry eye, and droopy eyelids.

While these risks are rare, it is crucial to discuss them with your doctor prior to undergoing the procedure.


The Laser Lens Treatment or RLE is the most popular treatment for patients over the age of 50 due to the versatility of the procedure. Patient are always shocked to hear this is even in option. This procedure can provide a customized vision correction experience tailored to the unique needs of each patient. With the right care and guidance from our experienced team at LASIK San Antonio, RLE can be a life-changing vision correction option for you.

Frequently Asked Questions

Is refractive lens exchange worth it?

Refractive lens exchange offers many benefits, such as improved vision and a permanent solution for various eye conditions. It is certainly worth considering if you feel tired of wearing glasses for reading fine print, are worried about spending money every year to buy new glasses, want to practice sports without worrying about contact lenses and glasses.

Have a pair of sunglasses that you have always wanted to wear but you can't because of your prescription glasses? Then RLE is the best option for you.

What is a refractive lens exchange?

Refractive Lens Exchange is an elective eye surgery that removes the natural lens and replaces it with an artificial intraocular lens to correct various vision issues, such as nearsightedness, astigmatism and age-related farsightedness.

The intraocular lens (IOL) contains a personalized vision prescription, similar to a contact lens or eyeglass lens.

What is the success rate of refractive lens exchange?

RLE has a high success rate when the goal is to correct refractive errors. Up to 95% of patients achieving clear vision without the help of glasses after surgery. It is most successful in correcting presbyopia and other age-related vision conditions.

Does insurance cover refractive lens exchange?

No, Insurance does not cover refractive lens exchange as it is considered an elective procedure. But the money savings after RLE are quite significant tot he point that the surgery will pay for itself after a few years.

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