Refractive Lens Exchange Goals

The goal of Refractive Lens Exchange surgery is to correct a persons vision by replacing the eye’s natural lens with an artificial lens. This is a great option for someone over the age of 45 who is looking to achieve bi-latteral distance, intermediate and close-up vision without dependence on glasses. Often patients come to Morris Eye Group interested in the LASIK procedure but then discover the benefits of Refractive Lens Exchange. LASIK is a great option for those that either want clear distance vision (and are OK with reading glasses) or want monovision (one eye made for distance and the other made for close-up). However, a lot of patients want the option of having both eyes see well at all distances. The only surgical procedure to attain vision at all distances is with Refractive Lens Exchange. Once a patient has had Refractive Lens Exchange they will never need to have cataract surgery because Refractive Lens Exchange is essentially early cataract surgery.

During the surgery, the ophthalmologist (eye surgeon) removes the clear, natural lens of the eye and inserts a new artificial lens called an intraocular lens or IOL. The procedure takes about fifteen minutes per eye, and after surgery, the patient can expect to heal within about a week or two. With the multifocal implant, patients can expect to see at all vision ranges (i.e. near, intermediate, and far) with limited dependence on glasses, if any. If the patient has corneal astigmatism, then they may need to have that refractive error corrected with another procedure at the time of the refractive lens exchange, or after they are healed completely. At Morris Eye Group, there is no extra charge for this. These procedures are performed in a sterilized surgical facility. Only one eye is done at a time, but can be completed within a week of each other.

Multifocal Lens

The Multifocal IOL is a lens with multiple focal points, designed to provide a full range of vision at all distances. This lens will give the patient enhanced vision quality in the near, in-between, and distance ranges.  Most people will not need to use glasses or contacts at all anymore.

Further Options

Patients with nearsightedness and farsightedness often have an astigmatism. Astigmatism is caused by an irregularly shaped cornea; instead of being round like a basketball, the cornea is shaped like a football. This can cause blurry vision.

Limbal Relaxing Incision (LRI): In addition to the Toric IOL, astigmatism can also be reduced by a procedure called a Limbal Relaxing Incision (LRI). The LRI can accompany the Monofocal IOL or the Multifocal IOL.  This procedure can be performed at the same time as the cataract operation, or as a separate procedure at a later date. A Limbal Relaxing Incision (LRI) is a small incision that the ophthalmologist makes into your cornea to make its shape rounder. Alternatively, the surgeon may elect to perform PRK to further reduce the astigmatism if the LRI is unsuccessful. Healing time is usually about a week.

PRK: If needed, PRK is another treatment for patients looking to reduce or eliminate astigmatism after Refractive Lens Exchange. Once the patient has healed completely from the Refractive Lens Exchange, and the doctor has deemed them a good candidate, a patient may proceed with PRK Laser Treatment.  Before the actual laser treatment takes place to reshape the cornea for astigmatism correction, a tiny amount of tissue (the top surface lining called the epithelium) is removed. The epithelium grows back over the course of about a week. Because of this, healing time can vary from patient to patient.

Appointments

Complimentary Consultation: At Morris Eye Group we offer different techniques for accomplishing refractive enhancing procedures.  We offer a complimentary consultation to help determine what procedure(s) would be best for the patient.  At this visit, the patient has a vision exam as well as topographical imaging of the cornea. These measurements help the doctor to understand the patient’s vision and what options are available to accomplish the patient’s visual goals. The doctor examines the patient and goes over all vision correcting options. If the patient is deemed a candidate for Refractive Lens Exchange, or another procedure, all other appointments are then scheduled.

Pre-Operative Appointment: At Morris Eye Group we do a very thorough exam with the patient to rule out any possible reasons a patient would not qualify for a procedure or a specific lens option.  Between the Lens Evaluation and the Pre-Operative Appointment, the information and tests we perform include: Health History, Automated refraction, full refraction Ascan, Manual K’s, Topography, OCT, ONA, Pachymetry, History and Physical, Contact lens trial fitting to assess refractive error if needed, testing to assess refractive error, Routine eye care, wellness care, or preventative care (to cope with refractive error). The patient is given pre and post operative instructions, and prescriptions for eye drops.

Procedure Day: Refractive Lens Exchange surgery is performed at one of three Ambulatory Centers our ophthalmologists are affiliated with: North Coast Surgery Center (Oceanside), Center For Surgery of Encinitas, or Scripps Encinitas Surgery Center. On the procedure day, the patient will need a driver and can expect to be at the facility for an approximately 3 hours.  The patient will be taken back to the pre-operative area by a nurse. They will prepare the patient for surgery by cleaning the eye area, using various eye drops (including numbing eye drops), and start an I.V. for anesthesia. The patient will NOT be under general anesthesia, and will be awake; however, the patient will be very comfortable.  The procedure itself takes about fifteen minutes. After the procedure, the patient will wait in recovery until a nurse has discharged them.  Patients go home and relax or take a nap. Most patients that have Refractive Lens Exchange see well within 24 hours of the procedure, though, healing time between patients can vary.

Post-Operative Care: The first post-operative appointment will be the day after the Refractive Lens Exchange procedure.  The patient can expect to have other post-operative appointments in the following weeks after the procedure is complete. There is a series of eye drops that the patient is asked to abide by (which our surgical technician goes over with the patient at the Pre-Operative appointment).

Further Appointments: Before any further treatments, such as an LRI or PRK for astigmatism, it is important for the eye to be completely healed. Sometimes healing completely can take up to a few months before the doctor will recommend going forward with the LRI or PRK procedure.  However, both the LRI and PRK laser treatments are performed in our very own state-of-the-art Laser Center located in our Encinitas Office.