What Is Refractive Lens Exchange (RLE) Surgery?
Refractive lens exchange (RLE) surgery is a type of lens replacement surgery in which your eye’s natural lens is replaced with an artificial intraocular lens (IOL) made of silicone or acrylic. Once in the eye, IOLs cannot be felt or seen and are designed to stay in your eye permanently. If you do experience problems with your IOLs, they can easily be removed and replaced without damaging your eye.
RLE surgery is used to correct refractive errors in people who have hyperopia or presbyopia and who are not suitable for laser eye surgery, but who don’t want to continue wearing glasses or regular contact lenses. It can also treat myopia and astigmatism, but laser eye surgery is generally the preferred treatment as it can achieve a greater degree of accuracy. RLE surgery is an extremely safe procedure, with a success rate of approximately 98% in the UK.
Am I Eligible For RLE Surgery?
There are certain conditions that must be met in order to qualify for RLE surgery, meaning that not everyone is eligible for the procedure. Your ophthalmologist will conduct an evaluation of your ocular and overall health, and will deem you suitable for the surgery if you:
- Suffer from hyperopia (farsightedness) and/or presbyopia (age-related farsightedness).
- Are over the age of 40 and may have been denied other types of treatment such as laser eye surgery.
- Have thin corneas which make undergoing laser eye surgery unsafe.
- Have had a stable prescription for at least one year.
- Do not have any pre-existing eye infections or diseases such as glaucoma and macular degeneration.
- Are not allergic to anaesthesia which is administered into the eye.
- Have a good overall health.
You will not be considered suitable for the surgery if you:
- Have diabetes, herpes or hepatitis C.
- Are pregnant or breastfeeding
- Have a pacemaker
- Have an autoimmune disease, such as lupus or rheumatoid arthritis.
- Are taking immunosuppressant drugs.
- Have corneal scars.
- Have suffered from eye trauma or retinal detachment.
Intraocular Lens (IOL) Types
There are four main types of intraocular lens (IOL) used in RLE surgery to correct hyperopia and presbyopia. The type of IOL that will be inserted into your eye will depend on the refractive error you have. The most common types of IOL are:
Monofocal: this lens focuses your vision at a single set distance – either near, far or intermediate distance – but is most commonly used to enable you to see clearly over long distances. Patients with this lens typically need glasses to carry out near distance tasks such as reading.
Multifocal: unlike monofocal lenses, this lens allows you to focus at both near and far distances therefore eliminating the need for you to wear glasses.
Accommodating: like multifocal lenses, this lens allows you to focus clearly at various distances. Accommodating lenses fit the shape of the eye more closely than other IOLs, but patients with this lens often still require glasses for near distance vision.
Toric: this lens helps you too see clearly over long distances, but like with monofocal and accommodating lenses, toric lenses require you to use glasses for near distance tasks. These lenses are typically designed to correct moderate to high corneal astigmatism.
RLE Surgery Cost
The average cost of RLE surgery in the UK is around £3,000 per eye. This cost comparison table shows you how much you should expect to pay for RLE surgery at some of the UK’s top eye surgery clinics:
|Clinic||Price Per Eye|
|Advanced Vision Care||From £2950|
|Accuvision||Quote available on request|
|Centre for Sight||From £2975|
|Optical Express||From £1995|
It is important to remember that these prices are the very lowest that clinics advertise, and are typically only offered to patients with a very mild refractive error. If the price you get quoted is considerably more you shouldn’t be surprised.
The cost of surgery will vary between clinics. This is influenced by a number of factors, such as:
- The experience of the surgeon: surgeons who have carried out a large number of procedures are likely to be more skilled, which will drive up the cost. The Royal College of Ophthalmologists award certifications to surgeons who have carried out over 300 operations over a two year period.
- The technology: clinics with newer and more advanced eye surgery technology will charge a higher price. This will be cost-effective for you however, as it will make the surgery quicker and more precise.
- The location: clinics in busy urban areas are likely to offer cheaper surgery due to the greater competition which will often cause them to lower their prices.
It is important to check what is included in the advertised price, and what is excluded. Some clinics charge extra for services such as consultations and follow-up appointments. These costs can quickly add up, making the overall price of your RLE surgery much more than you had initially expected. We recommend that you compare quotes from several clinics to find one which is best suited to your budget.
The type of lens that is inserted into your eye will also affect the price you will pay for surgery. The table below shows you the typical price per eye for the different types of IOLs used in RLE surgery:
|Type Of IOL||Price Per Eye|
As you can see, multifocal and accommodating lenses are more expensive since they correct vision at more than one distance.
Can I Get RLE Surgery On Finance?
Some people find finance options beneficial when paying for RLE surgery. Finance options allow you to pay an initial deposit for your treatment, followed by small monthly amounts over a pre-agreed period of time.
Below is a comparison table of the finance packages for RLE surgery offered by the UK’s best eye surgery clinics. It shows you how much you should expect to pay for the deposit, as well as the monthly instalment amounts for the shortest and longest payback period offered by each clinic.
|Clinic||Deposit||Shortest Payback Period||Longest Payback Period|
|Advanced Vision Care||From £1250||0% APR x 18 months = from £94.44 per month||Quote available on request|
|Accuvision||Quote available on request||Quote available on request||Quote available on request|
|Centre for Sight||Quote available on request||Quote available on request||0% APR x 24 months = from £94 per month|
|Optegra||From £349.50||0% APR x 12 months = from £262.12 per month||0% APR x 24 months = from £131.06 per month|
|Optical Express||From £500||0% APR x 10 months = from £149.50 per month||11.5% APR x 72 months = from £28.40 per month|
|Optimax||From £500||Quote available on request||11.5% APR x 48 months = from £64 per month|
|Ultralase||Quote available on request||Quote available on request||11.5% APR x 36 months = from £64.40 per month|
When considering entering into a financial agreement, you should acknowledge these important factors:
- You will need to be able to pay the initial deposit upfront, which is usually around 10% of the overall cost of your surgery. Since RLE surgery is a significant investment the deposit amount can be quite large so you must ensure you have enough money to fund this.
- Interest rates typically increase the longer your chosen payback period, meaning the more money you will owe the clinic. It is advisable therefore to opt for a shorter payback period if possible.
- Paying for things on finance can affect your credit score, so it is important to keep up with your payments as this can affect your ability to enter into financial agreements in the future.
- It is important to read the terms and conditions of your agreement carefully and make sure you understand them fully. You should ask if anything is unclear.
Can I Get RLE Surgery On The NHS?
Unfortunately, RLE surgery is not available on the NHS since refractive errors such as hyperopia and presbyopia can be corrected by wearing glasses or contact lenses. Eye surgery is only offered on the NHS in those cases where the condition can lead to blindness if left untreated.
RLE Surgery Procedure
- An ophthalmologist will take measurements of your eyes to determine which type of intraocular lens (IOL) will be most suitable for you.
- The surgery will take approximately 15 minutes to complete.
- If both your eyes need surgery they will be operated on separately, usually around a week apart. This is to allow for your first eye to recover and for your vision to stabilise.
- Anaesthesia will be administered to your eye, usually in the form of eye drops or an injection into the surrounding tissue.
- A small incision will be made into your cornea.
- The IOL will be implanted into your eye and positioned where your natural lens sat.
- The incision on your cornea will be left to heal naturally.
- You will be able to leave a few hours after undergoing the surgery.
- You should have improvements in vision immediately after surgery and clear vision within 4-6 weeks.
- You will be prescribed eye drops help with any redness or mild pain.
- You might feel some minor discomfort in the few days following surgery, such as blurred vision, headaches and halos.
- You should arrange for someone to drive you home as driving immediately after the procedure is not permitted.
- You will be able to return to work a week after the surgery.
To ensure the best recovery, you should follow all the post-operative instructions your surgeon gives you.
Is There Anything I Should Avoid After Surgery?
In order to assist with your recovery, there are a few things you shouldn’t do following your surgery. These include avoiding:
- Touching your eyes and getting anything in them such as sweat, dust, smoke or shampoo.
- Swimming for at least two weeks.
- Vigorous exercise such as boxing and lifting heavy weights.
- Wearing eye makeup for at least a week.
RLE Surgery Risks
Whilst RLE surgery is an extremely safe procedure, as with any medical treatment there are risks involved. Some complications that may occur are:
Common side effects:
- Blurred vision, glare and halos.
- Infection: this can be treated easily with antibiotics.
- Increased pressure in the eye (ocular hypertension): if picked up early this can be easily treated with medication, usually eye drops.
Rare side effects:
- Dislocated IOL: this occurs when the IOL inserted into the eye moves out of position. A dislocated IOL is either manipulated back into place or is removed and replaced. This is performed in the same way as the original surgery with similar recovery time.
- Retinal detachment: this occurs when the lining at the back of your eye begins to pull away from the blood vessels that supply it with oxygen and nutrients. It can be fixed by further surgery but some visual clearness will be lost.
- Droopy eyelid (ptosis): this will need surgery to correct it with a recovery time of around two weeks.
If you develop any of these side effects you should contact a healthcare professional immediately. The vast majority of patients do not experience any complications however, and RLE surgery continues to be the most successful procedure to permanently correct vision for those over the age of 40.